_TIP_U5760_Preliminary_JD_Request_REV

Jurisdictional Determination Request
US Army Corps
of Engineers.
Wilmington District
This form is intended for use by anyone requesting a jurisdictional determination QD)from the
U.S. Army Corps of Engineers, Wilmington District(Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
to the appropriate Corps Field Office (or project manager, if known)via mail, electronic mail, or
facsimile. A current list of county assignments by Field Office and project manager can be
fond on-line at: http://www.saw.usace.army.mil/Missions/RegulatoryPermitPro rg am.aspx , by
telephoning: 910-251-4633, or by contacting any of the field offices listed below:
ASHEVILLE REGULATORY FIELD OFFICE WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers US Army Corps of Engineers
151 Patton Avenue,Room 208 2407 West Fifth Street
Asheville,North Carolina 28801-5006 Washington,North Carolina 27889
General Number: [phone] General Number: [phone]
Fax Number: [phone] Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105 69 Darlington Avenue
Wake Forest,North Carolina 27587 Wilmington,North Carolina 28403
General Number: [phone] General Number: 910-251-4633
Fax Number: [phone] Fax Number: [phone]
Version: December 2013 Page 1

Jurisdictional Determination Request
INSTRUCTIONS:
All requestors must complete Parts A, B, C,D, E and F.
If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part G.
Please be aware that all JD
requests must include the current property owner authorization for the Corps to proceed with the
determination, which may include inspection of the property when necessary. This form must be
signed by the current property owner to be considered a complete request.
Property owner authorization/notification for JD
requests associated with North Carolina Department of Transportation (NCDOT)projects will be
conducted according to the current NCDOT/USACE protocols.
A Corps approved or preliminary JD may not
be valid for the wetland conservation provisions of the Food Security Act of 1985. If you or
your tenant are USDA Program participants, or anticipate participation in USDA programs, you
should also request a certified wetland determination from the local office of the Natural
RPcrmirr`Pc Cnncam7atinn CPm71r`P nrinr to ctartincr Az7n1-lr
Version: December 2013 Page 2

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: N/A Linear Transportation Project
City, State: Kernersville,North Carolina
County: Forsyth
Dir ecti Vila: See Figure 1:Vicinity Map
Parcel Index Number(s) (PIN): N/A(Linear Transportation Project)
B. REQUESTOR INFORMATION
Name: NCDOT;ATTN:Jeff Hemphill,Natural Environment Section
Mailing Address: 1598 Mail Service Center; Raleigh,NC 27699-1598
Telephone Number: 919-707-6126
Electronic Mail Addressi: [e-mail]
Select one:
❑✓ I am the current property owner.
❑ I am an Authorized Agent or Environmental Consultant
❑ Interested Buyer or Under Contract to Purchase
❑ Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: NCDOT;ATTN:Jeff Hemphill,Natural Environment Section
Mailing Address: 1598 Mail Service Center
Raleigh, NC 27699-1598
Telephone Number: 919-707-6126
Electronic Mail Address i: [e-mail]
❑Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel/Tax Record data)
l If available
Z Must attach completed Agent Authorization Form
3 If available
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Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION'
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on-site investigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.
Property Owner(please print) Date
Property Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
❑✓ I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does include a delineation.
❑ I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.
❑ I am requesting that the Corps investigate the property/project area for the presence or
absence of WOUS5 and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
❑ I am requesting that the Corps delineate the boundaries of all WoUS on a property/project
area and provide an approved JD (this may or may not include a survey plat).
❑ I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey plat).
4 For NCDOT requests following the current NCDOT/USACE protocols,skip to Part E.
5 Waters of the United States
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Jurisdictional Determination Request
F. ALL REQUESTS
❑✓ Map of Property or Project Area (attached). This Map must clearly depict the boundaries
of the area of evaluation.
❑✓ Size of Property or Project Area 674.25 acres
I verify that the property (or project)boundaries have recently been surveyed and marked
by a licensed land surveyor OR are otherwise clearly marked or distinguishable.
G. JD REQUESTS FROM CONSULTANTS OR AGENCIES
(1) Preliminary JD Requests:
Completed and signed Preliminary Jurisdictional Determination Form6.
Project Coordinates: 36.111732 Latitude -80.106633 Longitude
Maps (no larger than I Ix17)with Project Boundary Overlay:
❑✓ Large and small scale maps that depict, at minimum: streets, intersections, towns
Aerial Photography of the project area
USGS Topographic Map
❑✓ Soil Survey Map
❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
6 See Appendix A of this Form. From Regulatory Guidance Letter No.08-02,dated June 26, 2008
Version: December 2013 Page 5

Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands: Tributaries:
❑✓ Wetland Data Sheets USACE Assessment Forms
Upland Data Sheets Other Assessment Forms
(when appropriate)
❑ Landscape Photos, if taken
❑✓ Field Sketch overlain on legible Map that includes:
■ All aquatic resources (for sites with multiple resources, label and identify)
■ Locations of wetland data points and/or tributary assessment reaches
■ Locations of photo stations
■ Approximate acreage/linear footage of aquatic resources
(2) Approved 7Ds including Verification of a Delineation:
❑ Project Coordinates: Latitude Longitude
Maps (no larger than 11x17)with Project Boundary Overlay:
❑ Large and small scale maps that depict, at minimum: streets, intersections, towns
❑ Aerial Photography of the project area
❑ USGS Topographic Map
❑ Soil Survey Map
❑ Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)
1987 Manual Regional Supplements and Data forms can be found at:
http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits/reg supp.aspx
Wetland and Stream Assessment Methodologies can be found at:
http://Portal.ncdenr.org/c/document library/get file?uuid=76f3c58b-dab8-4960-ba43-45b7faf06f4c&groupld=38364 and,
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/publicnotices/2013/NCSAM Draft User Manual 130318.pdf
8 Delineation information must include,at minimum,one wetland data sheet for each wetland/community type.
Version: December 2013 Page 6

Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands: Tributaries:
❑ Wetland Data Sheets ❑ USACE Assessment Forms
❑ Upland Data Sheets ❑ Other Assessment Forms
(when appropriate)
❑ Landscape Photos, if taken
❑ Field Sketch overlain on legible Map that includes:
• All aquatic resources (for sites with multiple resources, label and identify)
• Locations of wetland data points and/or tributary assessment reaches
• Locations of photo stations
• Approximate acreage/linear footage of aquatic resources
Supporting Jurisdictional Information (for Approved JDs only)
❑ Approved Jurisdictional Determination Form(s) (also known as "Rapanos
Form(s)")
❑ Map(s) depicting the potential (or lack of potential) hydrologic connection(s),
adjacency, etc. to navigable waters.
9 Delineation information must include, at minimum,one wetland data sheet for each wetland/community type.
Version: December 2013 Page 7

Jurisdictional Determination Request
I. REQUESTS FOR CORPS APPROVAL OF SURVEY PLAT
Prior to final production of a Plat, the Wilmington District recommends that the Land
Surveyor electronically submit a draft of a Survey Plat to the Corps project manager for
review.
Due to storage limitations of our administrative records, the Corps requires that all hard-
copy submittals include at least one original Plat(to scale)that is no larger than 11"xl7"
(the use of match lines for larger tracts acceptable). Additional copies of a plat, including
those larger than 11"xl7", may also be submitted for Corps signature as needed. The
Corps also accepts electronic submittals of plats, such as those transmitted as a Portable
Document Format(PDF) file. Upon verification, the Corps can electronically sign these
n n nlate ad ratrn therm v mil ia a- a to flip rpn ipcfr\r
(1) PLATS SUBMITTED FOR APPROVAL
❑ Must be sealed and signed by a licensed professional land surveyor
❑ Must be to scale (all maps must include both a graphic scale and a verbal scale)
❑ Must be legible
❑ Must include a North Arrow, Scale(s), Title, Property Information
❑ Must include a legible WoUS Delineation Table of distances and bearings/metes
and bounds/GPS coordinates of all surveyed delineation points
❑ Must clearly depict surveyed property or project boundaries
❑ Must clearly identify the known surveyed point(s) used as reference (e.g. property
corner, USGS monument)
❑ When wetlands are depicted:
• Must include acreage (or square footage) of wetland polygons
• Must identify each wetland polygon using an alphanumeric system
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Jurisdictional Determination Request
❑ When tributaries are depicted:
• Must include either a surveyed, approximate centerline of tributary with
approximate width of tributary OR surveyed Ordinary High Water Marks
(OHWM)of tributary
• Must identify each tributary using an alphanumeric system
• Must include linear footage of tributaries and calculated area(using approximate
widths or surveyed OHWM)
• Must include name of tributary(based on the most recent USGS topographic
map) or,when no USGS name exists, identify as "unnamed tributary"
❑ all depicted WoUS (wetland polygons and tributary lines) must intersect or tie-to
surveyed project/property boundaries
❑ Must include the location of wetland data points and/or tributary assessment
reaches
❑ Must include, label accordingly, and depict acreage of all waters not currently
subject to the requirements of the CWA (e.g. "isolated wetlands", "non-
jurisdictional waters"). NOTE: An approved 7D must be conducted in order to
make an official Corps determination that a particular waterbody or wetland is not
jurisdictional.
❑ Must include and survey all existing conveyances (pipes, culverts, etc.)that
transport«WoT TS
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Jurisdictional Determination Request
(2) CERTIFICATION LANGUAGE
When the entire actual Jurisdictional Boundary is depicted:
include the following Corps Certification language:
"This certifies that this copy of this plat accurately depicts the boundary of the jurisdiction
of Section 404 of the Clean Water Act as determined by the undersigned on this date.
Unless there is a change in the law or our published regulations, the determination of
Section 404 jurisdiction may be relied upon for a period not to exceed five(5)years from
this date. The undersigned completed this determination utilizing the appropriate Regional
Supplement to the 1987 U.S. Army Corps of Engineers Wetlands Delineation Manual."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
When uplands may present within a depicted Jurisdictional Boundary_
include the following Corps Certification language:
"This certifies that this copy of this plat identifies all areas of waters of the United States
regulated pursuant to Section 404 of the Clean Water Act as determined by the
undersigned on this date. Unless there is change in the law or our published regulations,
this determination of Section 404 jurisdiction may be relied upon for a period not to exceed
five years from this date. The undersigned completed this determination utilizing the
appropriate Regional Supplement to the 1987 U.S. Army Corps of Engineers Wetlands
Delineation Manual."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
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Jurisdictional Determination Request
(3) GPS SURVEYS
For Surveys prepared using a Global Positioning System (GPS), the Survey must include
all of the above, as well as:
❑ be at sub-meter accuracy at each survey point.
❑ include an accuracy verification:
One or more known points (property corner, monument) shall be located with the
GPS and cross-referenced with the existing traditional property survey (metes and
bounds).
❑ include a brief description of the GPS equipment utilized.
Version: December 2013 Page 11

ATTACHMENT A
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
NCDOT;ATTN:Jeff Hemphill,Natural Environment Section
1598 Mail Service Center; Raleigh, NC 27699-1598
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES AT DIFFERENT
SITES)
State: NC County/parish/borough: Forsyth City: Kernersville
Center coordinates of site (lat/long in degree decimal format):
Lat. 36.111732 ON; Long, 80.106633 Ow.
Universal Transverse Mercator: 17
Name of nearest waterbody: Smith Creek,Kerners Mill Creek
Identify (estimate) amount of waters in the review area:
Non-wetland waters:
17,448 linear feet: 3-25 width (ft) and/or 1.63 acres.
COwardin Class: Riverine, Lacustrine(PA, PI)
Stream Flow: PER(Kerners Mill Ck,Smith Ck,SD,SH-SJ,SN-SP,SS,SU-SW),INT (SA,SB,SG,SN,SR,ST,SX)
Wetlands: 3.84 acres.
COwardln Class: Palustrine
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal: N/A
Non-Tidal: NSA
1

E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
SUPPORTING DATA. Data reviewed for preliminary JD
(check all that apply - checked items should be included in case file and,
where checked and requested, appropriately reference sources below):
❑✓ Maps, plans, plots or plat submitted by or on behalf of the
applicant/consultant: NCOOT
❑ Data sheets prepared/submitted by or on behalf of the
applicant/consultant.
Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data
❑ USGS 8 and 12 digit HUC maps
❑✓ U.S. Geological Survey map(s). Cite scale & quad name: 1:24,000-(see"Other")
❑✓ USDA Natural Resources Conservation Service Soil Survey.
Citation: Forsyth County, 1976
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is:
(National Geodectic Vertical Datum of 1929)
❑✓ Photographs: ❑✓ Aerial (Name & Date): NC Statewide Orthoimagery Project(2014)or
❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
Other Information (please specify):Winston-Salem East, Kernersville,&Belews Creek Quads
2

1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide General Permit (NWP) or other general permit verification requiring
"pre-construction notification" (PCN), or requests verification for a non-reporting
NWP or other general permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP or other general permit authorization; (4)
that the applicant can accept a permit authorization and thereby agree to comply
with all the terms and conditions of that permit, including whatever mitigation
requirements the Corps has determined to be necessary; (5) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes any challenge to
such jurisdiction in any administrative or judicial compliance or enforcement
action, or in any administrative appeal or in any Federal court; and (7) whether
the applicant elects to use either an approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Further, an approved JD, a proffered
individual permit (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.
3

This preliminary JD finds that there "may be"waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be
affected by the proposed activity, based on the following information:
IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified bV the Corps and should not be relied upon for
later jurisdictional determinations.
Signature and date of Signature and date of
Regulatory Project Manager person requesting preliminary JD
(REQUIRED) (REQUIRED, unless obtaining
the signature is impracticable)
4

Estimated Class of
Site Latitude Longitude Cowardin amount of aquatic
number Class aquatic resource
resource
in review area
Kerners 36.1268 -80.1151 Riverine 1,075 linear feet non-section 10
Mill Creek —non-tidal
Smith Creek 36.1097 -80.1089 Riverine 4,432 linear feet non-section 10
—non-tidal
SA 36.1092 -80.0888 Riverine 10 linear feet non-section 10
—non-tidal
SB 36.1080 -80.1034 Riverine 275 linear feet non-section 10
—non-tidal
SD 36.1136 -80.1056 Riverine 1,775 linear feet non-section 10
—non-tidal
SG 36.1114 -80.1146 Riverine 164 linear feet non-section 10
—non-tidal
SH 36.1113 -80.1220 Riverine 566 linear feet non-section 10
—non-tidal
SI 36.1113 -80.1209 Riverine 426 linear feet non-section 10
—non-tidal
Si 36.1125 -80.1043 Riverine 1,252 linear feet non-section 10
—non-tidal
SM 36.1127 -80.1149 Riverine 531 linear feet non-section 10
—non-tidal
SN 36.1262 -80.1125 Riverine 1,441 linear feet non-section 10
—non-tidal
SO 36.1368 -80.1153 Riverine 21 linear feet non-section 10
—non-tidal
SP 36.1342 -80.1223 Riverine 73 linear feet non-section 10
—non-tidal
SR 36.1341 -80.1151 Riverine 36 linear feet non-section 10
—non-tidal
SS 36.1286 -80.1151 Riverine 2,420 linear feet non-section 10
—non-tidal
ST 36.1335 -80.1155 Riverine 91 linear feet non-section 10
—non-tidal
SU 36.1332 -80.1154 Riverine 131 linear feet non-section 10
—non-tidal
SV 36.1242 -80.1128 Riverine 1,994 linear feet non-section 10
—non-tidal
Sw 36.1236 -80.1129 Riverine 351 linear feet non-section 10
—non-tidal
SX 36.1094 -80.0903 Riverine 47 linear feet non-section 10
—non-tidal
ESE-S38 36.1122 -80.1147 Riverine 135 linear feet non-section 10
—non-tidal
5

ESE-S41 36.1122 -80.1147 Riverine 202 linear feet non-section 10
—non-tidal
PA 36.1141 -80.1051 Lacustrine 0.13 acre non-section 10
—non-tidal
PI 36.1250 -80.1110 Lacustrine 1.51 acres non-section 10
—non-tidal
WA 36.1079 -80.1067 Palustrine 0.55 acre non-section 10
—wetland
WB 36.1110 -80.1138 Palustrine 0.87 acre non-section 10
—wetland
WD 36.1113 -80.1132 Palustrine 0.17 acre non-section 10
—wetland
WE 36.1139 -80.1252 Palustrine 0.11 acre non-section 10
—wetland
WF 36.1254 -80.1118 Palustrine 0.11 acre non-section 10
—wetland
WG 36.1343 -80.1223 Palustrine 0.03 acre non-section 10
—wetland
WH 36.1341 -80.1223 Palustrine 0.02 acre non-section 10
—wetland
WI 36.1271 -80.1125 Palustrine 0.96 acre non-section 10
—wetland
WJ 36.1263 -80.1124 Palustrine 0.11 acre non-section 10
—wetland
WL 36.1337 -80.1152 Palustrine 0.003 acre non-section 10
—wetland
WM 36.1336 -80.1153 Palustrine 0.006 acre non-section 10
—wetland
WN 36.1337 -80.1157 Palustrine 0.01 acre non-section 10
—wetland
WO 36.1284 -80.1150 Palustrine 0.11 acre non-section 10
—wetland
WQ 36.1270 -80.1139 Palustrine 0.04 acre non-section 10
—wetland
WR 36.1269 -80.1143 Palustrine 0.06 acre non-section 10
—wetland
WS 36.1271 -80.1156 Palustrine 0.43 acre non-section 10
—wetland
ESE-W20 36.1118 -80.1214 Palustrine 0.14 acre non-section 10
—wetland
ESE-W21 36.1120 -80.1214 Palustrine 0.03 acre non-section 10
—wetland
ESE-W22 36.1115 -80.1131 Palustrine 0.08 acre non-section 10
—wetland
6

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TIP U-5760
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w�D�NORTy� Figure 3c: Jurisdictional Features Map
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=I Widen Big Mill Farm Road and Hopkins Road from
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°F Kernersville, Forsyth County

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Figure 3f: Jurisdictional Features Map
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z Widen Big Mill Farm Road and Hopkins Road from
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Figure 3f: Jurisdictional Features Map
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Widen Big Mill Farm Road and Hopkins Road from
4 south of 1-40 Business/US 421 to West Mountain Street
8
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z Widen Big Mill Farm Road and Hopkins Road from
� dFA �q south of 1-40 Business/US 421 to West Mountain Street
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i Widen Big Mill Farm Road and Hopkins Road from
south of 1-40 Business/US 421 to West Mountain Street
��F Kernersville, Forsyth County

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TIP U-5760
M Widen Big Mill Farm Road and Hopkins Road from
q south of 1-40 Business/US 421 to West Mountain Street
°F�' Kernersville, Forsyth County

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 2/2/2016 Project/Site: TIP U-5760 Latitude: 36.126744
Kerners Mill Creek
Evaluator: R.Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115208
Kimley-Horn
Total Points: 41 Stream Determination (cir Other
Stream is at least intermittent Ephemeral Intermitte Perennial e.g.Quad Name: Belews Creek
f>_19 or perennial if>_30
A. Geomorphology Subtotal = 25 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 3
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 3
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 0
10. Natural valley 0 0.5 1 1.5 1
11. Second or greater order channel No = 0 Yes= 3 3
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 1
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL= 1.5; Other= 0 0
`perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Kerners Mill Creek is a strong perennial channel with a sandy
substrate and areas of exposed clay in the bank. The banks are steep and the
stream is incised. It appears that berms were built along the stream west of
Hopkins Road to control flooding.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:02/02/2016 4.Time of evaluation:4:30 pm
5.Name of stream: Kerners MITI Creek 6.River basin:Yadkin
7.Approximate drainage area: 1,800 acres 8. Stream order:.Third Order
9.Length of reach evaluated: 1,100 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.126744 Longitude(ex.-77.55661 t): -80.115208
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated north of Timberwood Trl on each side of Hopkins Rd
14.Proposed channel work(if any): None
15.Recent weather conditions:The area received 0.03" of rain the day prior to the site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? YES 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 60%Residential 25 %Commercial _%Industrial _%Agricultural
15 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width:20' 23.Bank height(from bed to top of bank): 7'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends ✓Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 58 Comments:
Kerners Mill Creek is a strong perennial channel with a sandy substrate and areas of exposed clay in the bank. The banks are
steep and the stream is incised. It appears that berms were built along the stream west of Hopkins Road to control flooding.
Evaluator's Signature Yu1116u-am, Date 02/02/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Kerners Mill Creek
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 0-5 0-5 2
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 4
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 3
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 Q
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 3
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 4
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 3
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 3
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 3
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 4
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 3
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 58
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.109582
Smith Creek
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.107828
Kimley-Horn
Total Points: 38.5 Stream Determination (�erennial
Other
Stream is at least intermittent Ephemeral Intermittene.g.quad Name: Kernersville
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 23 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 2
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 2
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or greater order channel No = 0 Yes= 3 3
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 9.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Smith Creek is a perennial channel within a natural valley. Smith
Creek is deeply incised and multiple bank failures were observed along the
channel. A floodplain wetland was documented along Smith Creek within the
project corridor, but the floodplain is mostly drained.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/26/2016 4.Time of evaluation: 11:30 am
5.Name of stream:Smith Creek 6.River basin:Yadkin
7.Approximate drainage area: 1,650 acres 8. Stream order:.Second Order
9.Length of reach evaluated: 1,500 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.109582 Longitude(ex.-77.556611): -80.107828
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated west of Harmon Creek Rd's deadend and north of High Creek Ct
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? YES If yes,estimate the water surface area: 4.5 acres
19. Does channel appear on USGS quad map? YES 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 30%Residential 30%Commercial _%Industrial 5 %Agricultural
30 %Forested _%Cleared/Logged 5 %Other(Paved Roadway )
22.Bankfull width:25' 23.Bank height(from bed to top of bank): 8'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends ✓Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 54 Comments:
Smith Creek is a perennial channel within a natural valley. Smith Creek is deeply incised and multiple bank failures were
observed along the channel. A floodplain wetland was documented along Smith Creek within the project corridor, but the
floodplain is mostly drained.
Evaluator's Signature Yu1116u-am, Date 01/26/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Smith Creek
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 o-s o-s 3
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 3
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 1
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2
1
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 4
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 1
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 1
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 2
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 2
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 4
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 4
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 4
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 54
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.109150
Stream SA
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.088755
Kimley-Horn
Total Points: 24 Stream Deter (circle one) Other
Stream is at least intermittent Ephemera ntermittent erennial e.g.Quad Name: Kernersville
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 7 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 0
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 0
poolsequence
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 1.5
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or greater order channel No = 0 Yes= 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 11
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 3
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0
16. Organic debris lines or piles 0 0.5 1 1.5 0.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SA is an intermittent stream channel that is mostly piped and
only daylights within the project corridor for- 10'. The channel is linear. There
was strong flow during the site visit, but likely due to snow/ice melt from recent
snow event.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/26/2016 4.Time of evaluation:9:00 am
5.Name of stream:Stream SA 6.River basin:Yadkin
7.Approximate drainage area: 15 acres 8. Stream order:.First Order
9.Length of reach evaluated: 10 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.109150 Longitude(ex.-77.55661 t): -80.088755
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
Stream SA daylights in the corridor for 10' just south of Business 140 and north of Arbor Hill Rd
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit, but snow/ice was on the ground
16. Site conditions at time of visit: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? NO
21. Estimated watershed land use: _%Residential 85 %Commercial _%Industrial _%Agricultural
5 %Forested _%Cleared/Logged 10%Other(Paved Road
22.Bankfull width: 12' 23.Bank height(from bed to top of bank):4'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: _zStraight Occasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 20 Comments:
Stream SA is an intermittent stream channel that is mostly piped and only daylights within the project corridor for- 10'. The
channel is linear. There was strong flow during the site visit, but likely due to snow/ice melt from recent snow event.
Evaluator's Signature Yu1116u-am, Date 01/26/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change-version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SA
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 0-5 0-5 O
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 0
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 2
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 0
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 0
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 0
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 0
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 2
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 3
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 1
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 0
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 0
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 0
18 Canopy coverage over streambed 0—5 0—5 0—5 0
no shadingvegetation=0; continuous canopy=max points)
19 Substrate embeddedness NA* 0-4 0-4 2
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5 0
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 20
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.108034
Stream SB
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.103405
Kimley-Horn
Total Points: 28.5 Stream Determination (circle one) Other
Stream is at least intermittent Ephemera ntermitten erennial e.g.Quad Name: Kernersville
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 15.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 1
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 2
poolsequence
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 2
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1
11. Second or greater order channel No = 0 Yes= 3 3
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 7
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0
16. Organic debris lines or piles 0 0.5 1 1.5 0.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SB is a strong intermittent channel that has been mostly
piped under expansive commercial development. The stream is daylighted on
each side of Harmon Creek Road in fenced off natural areas that have steep
topography sloping towards the stream. Moderate baseflow was observed within
the channel, but is likely influenced by melting snow/ice from previous week.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/26/2016 4.Time of evaluation: 10:00 am
5.Name of stream:Stream SB 6.River basin:Yadkin
7.Approximate drainage area: 35 acres 8. Stream order:.Second Order
9.Length of reach evaluated: 275 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.108034 Longitude(ex.—77.556611): -80.103405
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
SB was evaluated on each side of Harmon Creek Road between the Wal-Mart Supercenter and Lowes Home Improvement
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? YES 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: _%Residential 85 %Commercial _%Industrial _%Agricultural
5 %Forested _%Cleared/Logged 10%Other(Paved Roadway )
22.Bankfull width:8' 23.Bank height(from bed to top of bank): 6'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: _zStraight Occasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 32 Comments:
Stream SB is a strong intermittent channel that has been mostly Qiped under expansive commercial development. The stream
is daylighted on each side of Harmon Creek Road in fenced off natural areas that have steep topography sloping towards the
stream. Moderate baseflow was observed within the channel, but is likely influenced by melting snow/ice from previous week.
Evaluator's Signature Yu1116u-am, Date 01/26/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SB
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 3
Evidence of past human alteration
2 0-6 0-5 0-5 O
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 2
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 0
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 0
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 0
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 1
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 1
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 1
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 3
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 1
18 Canopy coverage over streambed 0—5 0—5 0—5 3
no shadingvegetation=0; continuous canopy=max points)
19 Substrate embeddedness NA* 0-4 0-4 2
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5 0
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 32
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.113614
Stream SD
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.105637
Kimley-Horn
Total Points: 34.5 Stream Determination (�erennial
Other
Stream is at least intermittent Ephemeral Intermittene.g.quad Name: Kernersville
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 18 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 0
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 1
11. Second or greater order channel No = 0 Yes= 3 3
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SD is a perennial channel within a well-defined natural valley.
SD is slightly downcut and multiple bank failures were observed south of
Business 140. Numerous animal tracks were observed in and around SD.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/]. Hartshorn (Kimley-Horn)
3.Date of evaluation:01/26/2016 4.Time of evaluation: 11:00 am
5.Name of stream:Stream SD 6.River basin:Yadkin
7.Approximate drainage area: 161 acres 8. Stream order:.Second Order
9.Length of reach evaluated: 1,700 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.113614 Longitude(ex.-77.556611): -80.105637
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated just south of Business 140 from the culvert outlet to its confluence with Smith Creek
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? YES If yes,estimate the water surface area: 0.13 acres
19. Does channel appear on USGS quad map? YES 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 45 %Residential 10%Commercial _%Industrial _%Agricultural
35 %Forested _%Cleared/Logged 10%Other(Paved Roadway )
22.Bankfull width: 10' 23.Bank height(from bed to top of bank):4'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 51 Comments:
Stream SD is a perennial channel within a well-defined natural valley. SD is slightly downcut and multiple bank failures were
observed south of Business 140. Numerous animal tracks were observed in and around SD.
Evaluator's Signature Yu1116u-am, Date 01/26/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change-version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SD
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 o-s o-s 3
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 1
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 1
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 Q
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 1
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 2
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 2
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 4
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 4
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 0-4 0-5 0-5
(no evidence=0; common,numerous types=max points)
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 4
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 51
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.111608
Stream SG
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.114586
Kimley-Horn
Total Points: 25 Stream Determin ion (circle one) Other
Stream is at least intermittent Ephemera ntermitten erennial e.g.Quad Name: Kernersville
if>_19 or perennial if 2:30
A. Geomorphology Subtotal = 8.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 2
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 1
poolsequence
4. Particle size of stream substrate 0 1 2 3 1
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or greater order channel No = 0 Yes= 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10.5
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 3
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SG is a short incised feature that drains a large pond/wetland
system. SG forms just upstream of a farm road crossing. Strong iron oxidizing
bacteria observed within the channel. SG likely does not flood unless Smith
Creek overtops its bank.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/26/2016 4.Time of evaluation: 10:15 am
5.Name of stream:Stream SG 6.River basin:Yadkin
7.Approximate drainage area: 39 acres 8. Stream order:.First Order
9.Length of reach evaluated: 160 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.111608 Longitude(ex.-77.55661 t): -80.114586
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated south of Business 140 and east of Bluff School Road
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? YES 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 35 %Residential _%Commercial _%Industrial _%Agricultural
50 %Forested 15 %Cleared/Logged _%Other( 1
22.Bankfull width:8' 23.Bank height(from bed to top of bank):4'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 33 Comments:
Stream SG is a short incised feature that drains a large pond/wetland system. SG forms just upstream of a farm road crossing.
Strong iron oxidizing bacteria observed within the channel. SG likely does not flood unless Smith Creek overtops its bank.
Evaluator's Signature Yu1116u-am, Date 01/26/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SG
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 2
Evidence of past human alteration
2 0-6 0-5 0-5 2
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 Q
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 Q
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 Q
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 1
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 1
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 2
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 2
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 1
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 2
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 2
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 33
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/27/2016 Project/Site: TIP U-5760 Latitude: 36.111630
Stream SH
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.121753
Kimley-Horn
Total Points: 36.5 Stream Determination (circle one) Other
Stream is at least intermittent Ephemeral Intermitte erennia g.Quad Name: Kernersville
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 22.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or greater order channel No = 0 Yes= 3 3
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 4
18. Fibrous roots in streambed 3 2 1 0 2
19. Rooted upland plants in streambed 3 2 1 0 2
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SH is a meandering stream in a large topographic
crenulation. The banks are mostly stable due to tree roots, but occasional
failures are present along the reach. Large grade change between origin and
culvert has contributed to multiple headcuts in upper reach. Wetlands are
present along the lower reach.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/27/2016 4.Time of evaluation: 10:15 am
5.Name of stream:Stream SH 6.River basin:Yadkin
7.Approximate drainage area: 55 acres 8. Stream order:.Second Order
9.Length of reach evaluated: 500 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.111630 Longitude(ex.-77.55661 t): -80.121753
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated south of Business 140 and east of Bluff School Road
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 35 %Residential _%Commercial _%Industrial _%Agricultural
50 %Forested 15 %Cleared/Logged _%Other( 1
22.Bankfull width:T-101 23.Bank height(from bed to top of bank): T-5'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 51 Comments:
Stream SH is a meandering stream in a large topoaraphic crenulation. The banks are mostly stable due to tree roots, but
occasional failures are present along the reach. Large grade change between origin and culvert has contributed to multiple
headcuts in upper reach. Wetlands are present along the lower reach.
Evaluator's Signature Yu1116u-am, Date 01/27/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SH
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 o-s o-s 3
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 4
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 1
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 1
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 1
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 1
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 2
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 2
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 3
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 4
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 0-4 0-5 0-5
(no evidence=0; common,numerous types=max points)
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 3
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 51
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/27/2016 Project/Site: TIP U-5760 Latitude: 36.111453
Stream SI
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.120901
Kimley-Horn
Total Points: 25 Stream Determination (circle one) Other
Stream is at least intermittent Ephemeral Intermitte le.g.Quad Name: Kernersville
if>_19 or perennial if 2:30
A. Geomorphology Subtotal = 8.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 2
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 1
poolsequence
4. Particle size of stream substrate 0 1 2 3 1
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or greater order channel No = 0 Yes= 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10.5
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 3
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SI is a perennial stream that intersects with stream SH. The
stream has a strong baseflow and a steep grade change further upslope from
the confluence with SH.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/27/2016 4.Time of evaluation: 10:40 am
5.Name of stream:Stream SI 6.River basin:Yadkin
7.Approximate drainage area: 24 acres 8. Stream order:.First Order
9.Length of reach evaluated:400 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.111453 Longitude(ex.-77.556611): -80.120901
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated south of Business 140 and east of Bluff School Road
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 35 %Residential _%Commercial _%Industrial _%Agricultural
50 %Forested 15 %Cleared/Logged _%Other( 1
22.Bankfull width:T-61 23.Bank height(from bed to top of bank): V-101
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends ✓Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 42 Comments:
Stream SI is a perennial stream that intersects with stream SH. The stream has a strong baseflow and a steeQgrade change
further upslope from the confluence with SH.
Evaluator's Signature Yu1116u-am, Date 01/27/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SI
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 2
Evidence of past human alteration
2 0-6 o-s o-s 4
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 4
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 0
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 0
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 2
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 2
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 1
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 1
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 3
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 1
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 3
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 2
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5 0
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 2
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 42
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/27/2016 Project/Site: TIP U-5760 Latitude: 36.112541
Stream SJ
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.104295
Kimley-Horn
Total Points: 42.5 Stream Determination ci e Other
Stream is at least intermittent Ephemeral Intermitt t Perennial g.Quad Name: Kernersville
if>_19 or perennial if 2:30
A. Geomorphology Subtotal = 25 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 2
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or greater order channel No = 0 Yes= 3 3
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 0
15. Sediment on plants or debris 0 0.5 1 1.5 1.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 7.5
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 1.5
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SJ is a strong perennial stream beginning offsite. SJ flows
over bedrock with numerous boulders and rock formations observed within the
channel. Small fish were observed throughout the channel in the deeper pools.
Large depositional bars and benches were found throughout the reach. The
stream is deeply incised with numerous bank failures.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/]. Hartshorn (Kimley-Horn)
3.Date of evaluation:01/27/2016 4.Time of evaluation:8:30 pm
5.Name of stream:Stream SJ 6.River basin:Yadkin
7.Approximate drainage area:97 acres 8. Stream order:.Second Order
9.Length of reach evaluated: 1,200 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.112541 Longitude(ex.-77.55661 t): -80.104295
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated north of Business 140 beginning at the confluence with SD then heading upstream
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? YES 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 30%Residential 20%Commercial _%Industrial _%Agricultural
45 %Forested _%Cleared/Logged 5 %Other(Paved Roadway )
22.Bankfull width:25' 23.Bank height(from bed to top of bank): 6'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 52 Comments:
Stream SJ is a strong perennial stream beginning offsite. SJ flows over bedrock with numerous boulders and rock formations
observed within the channel. Small fish were observed throughout the channel in the deeper pools. Large depositional bars
and benches were found throughout the reach. The stream is deeply incised with numerous bank failures.
Evaluator's Signature Yu1116u-am, Date 01/27/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream S]
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 o-s o-s 3
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 2
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 1
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 Q
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 1
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 2
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 2
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 3
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 4
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 2
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 3
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 52
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form, Version 4.11
Date: 1/27/2016 Project/Site: TIP U-5760 Latitude: 36.112611
Stream SM
Evaluator: R.Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115224
Kimley-Horn
Total Points: 31.5 Stream Determination (cir Other
Stream is at least intermittent Ephemeral Intermitten erennial e.g.Quad Name: Kernersville
if>19 or perennial if>_30
A. Geomorphology Subtotal = 16.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 1
3. In-channel structure: ex. riffle-pool, step-pool,
ripple-pool sequence 0 1 2 3 3
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1.5
10. Natural valley 0 0.5 1 1.5 0
11. Second or greater order channel No = 0 Yes = 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 9
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SM is a well-defined perennial channel flowing along the
western edge of pond PK. The stream appears to have been relocated and does
not flow through the man-made fish hatchery ponds. Strong flow was observed
within SM along with good structure development and substrate sorting in bed.
Few trees or shrubs along the reach.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/27/2016 4.Time of evaluation: 5:15 pm
5.Name of stream:Stream SM 6.River basin:Yadkin
7.Approximate drainage area:60 acres 8. Stream order:.First Order
9.Length of reach evaluated:600 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.112611 Longitude(ex.-77.55661 t): -80.115224
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated north of Business 140 along the western edge of pond PK
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? YES 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 30%Residential 20%Commercial _%Industrial _%Agricultural
45 %Forested _%Cleared/Logged 5 %Other(Paved Roadway )
22.Bankfull width:5' 23.Bank height(from bed to top of bank): 2'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 30 Comments:
Stream SM is a well-defined perennial channel flowing along the western edge of pond PK. The stream appears to have been
relocated and does not flow through the man-made fish hatche[y Qonds. Strong flow was observed within SM along with good
structure development and substrate sorting in bed. Few trees or shrubs along the reach.
Evaluator's Signature Yu1116u-am, Date 01/27/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SM
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of now/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 0-5 0-5 O
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 0
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 0
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 0
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 0
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 2
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 2
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 2
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 1
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 0
18 Canopy coverage over streambed 0—5 0—5 0—5 0
no shadingvegetation=0; continuous canopy=max points)
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5 0
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 30
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.123129
Stream SN-INT
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.109154
Kimley-Horn
Total Points: 26 Stream Deter ' n (circle one) Other
Stream is at least intermittent Ephemera ntermittent erennial e.g.Quad Name: Kernersville
if>_19 or perennial if 2:30
A. Geomorphology Subtotal = 14 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 2
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 2
poolsequence
4. Particle size of stream substrate 0 1 2 3 1
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 1
11. Second or greater order channel No = 0 Yes= 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 8
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 0.5
15. Sediment on plants or debris 0 0.5 1 1.5 1
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 4
18. Fibrous roots in streambed 3 2 1 0 0
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 1
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SN-Intermittent begins at a headcut downslope from multiple
stormwater outlets. The channel is confined by residential development on all
sides and multiple bank failures are present along the reach.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/28/2016 4.Time of evaluation: 10:00 am
5.Name of stream:Stream SN-INTERMITTENT 6.River basin:Yadkin
7.Approximate drainage area: 30 acres 8. Stream order:.First Order
9.Length of reach evaluated: 735 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.123129 Longitude(ex.-77.556611): -80.109154
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated from its origin just north of Ashley Park Dr to the culvert inlet at Woodfield Dr
14.Proposed channel work(if any): None
15.Recent weather conditions: MOStIy sunny and cool with —0.01" of rain the night prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 75 %Residential _%Commercial _%Industrial _%Agricultural
25 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width:4' 23.Bank height(from bed to top of bank): 1
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: _zStraight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 43 Comments:
Stream SN-Intermittent begins at a headcut downslope from multiple stormwater outlets. The channel is confined by
residential development on all sides and multiple bank failures are present along the reach.
Evaluator's Signature Yu1116u-am, Date 01/28/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SN-INTERMITTENT
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 3
Evidence of past human alteration
2 0-6 0-5 0-5 O
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 1
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 2
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 2
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 2
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 1
11 Size&diversity of channel bed substrate NA* 0-4 0-5 2
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
� 12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 2
E* Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 2
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 1
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 3
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 2
18 Canopy coverage over streambed 0—5 0—5 0—5 3
no shadingvegetation=0; continuous canopy=max points)
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 0-4 0-5 0-5
(no evidence=0; common,numerous types=max points)
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 2
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 43
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.126193
Stream SN-PER
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.112487
Kimley-Horn
Total Points: 32 Stream Determination (�erennial
Other
Stream is at least intermittent Ephemeral Intermittene.g.quad Name: Belews Creek
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 16.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or greater order channel No = 0 Yes= 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 9
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6.5
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0.5
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: SN-PER is the reach of SN downslope of a large (1.5 acre) pond
outlet . Flow is strong and the channel is well-defined. The culvert outlet
draining from upslope pond is perched -4'above stream bed. Much of the
reach has been channelized into a ditch along Hopkins Road until the
confluence with Kerners Mill Creek.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/28/2016 4.Time of evaluation: 12:30 pm
5.Name of stream:Stream SN-PERENNIAL 6.River basin:Yadkin
7.Approximate drainage area: 57 acres 8. Stream order:.First Order
9.Length of reach evaluated: 788 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.126193 Longitude(ex.-77.55661 t): -80.112487
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated downslope from large man-made pond east of Hopkins Rd
14.Proposed channel work(if any): None
15.Recent weather conditions: MOStIy sunny and cool with -0.01" of rain the night prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? YES If yes,estimate the water surface area: 1.5 acres
19. Does channel appear on USGS quad map? YES 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 40%Residential _%Commercial _%Industrial _%Agricultural
60 %Forested _%Cleared/Logged _%Other( )
22.Bankfull width:4' 23.Bank height(from bed to top of bank): 1
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: _zStraight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 47 Comments:
SN-PER is the reach of SN downslope of a large (1.5 acre) pond outlet. Flow is strong and the channel is well-defined. The
culvert outlet draining from upslope pond is perched - 4'above stream bed. Much of the reach has been channelized into a
ditch along Hopkins Road until the confluence with Kerners Mill Creek.
Evaluator's Signature Yu1116u-am, Date 01/28/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change-version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SN-PERENNIAL
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 0-5 0-5 1
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 2
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 2
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 2
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 2
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 3
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 3
11 Size&diversity of channel bed substrate NA* 0-4 0-5 2
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
� 12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 2
E* Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 3
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 2
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 1
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 1
19 Substrate embeddedness NA* 0-4 0-4 2
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 0-4 0-5 0-5
(no evidence=0; common,numerous types=max points)
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 2
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 47
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.136791
Stream SO
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.115314
Kimley-Horn
Total Points: 33.5 Stream Determination (�erennial
Other
Stream is at least intermittent Ephemeral Intermittene.g.quad Name: Belews Creek
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 16 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 1
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 2
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 3
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or greater order channel No = 0 Yes= 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 11.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 1.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SO begins at a large headcut below multiple overland
drainage flows. SO is deeply incised and intercepts groundwater. The channel
has incised down to a clay layer that appears more resistant to erosion than the
upper layers of soil.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/28/2016 4.Time of evaluation:4:30 pm
5.Name of stream:Stream SO 6.River basin: Roanoke
7.Approximate drainage area: 18 acres 8. Stream order:.First Order
9.Length of reach evaluated: 39 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.136791 Longitude(ex.-77.556611): -80.115314
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated north of NC 66 and west of Fulp Rd
14.Proposed channel work(if any): None
15.Recent weather conditions: MOStIy sunny and cool with —0.01" of rain the night prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: _%Residential 85 %Commercial _%Industrial _%Agricultural
15 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width:6' 23.Bank height(from bed to top of bank): 8'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: _zStraight Occasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 38 Comments:
Stream SO begins at a large headcut below multiple overland drainage flows. SO is deeply incised and intercepts groundwater.
The channel has incised down to a clay layer that appears more resistant to erosion than the upper layers of soil.
Evaluator's Signature Yu1116u-am, Date 01/28/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SO
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 3
Evidence of past human alteration
2 0-6 o-s o-s 4
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 2
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 0
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 0
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 0
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 1
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 0
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 1
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 2
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 3
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 3
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 1
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 4
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5 0
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 38
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.134176
Stream SP
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.122372
Kimley-Horn
Total Points: 32 Stream Determination (�erennial
Other
Stream is at least intermittent Ephemeral Intermittene.g.quad Name: Belews Creek
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 16 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 2
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 2
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 0
10. Natural valley 0 0.5 1 1.5 1
11. Second or greater order channel No = 0 Yes= 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SP is a perennial feature that begins at a culvert outlet that
drains multiple wash bays at a large industrial concrete mixing plant. The
stream is incised and has little woody riparian vegetation within the project
study area. The grass is mowed/maintained up to the stream banks.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:01/28/2016 4.Time of evaluation: 5:00 pm
5.Name of stream:Stream SP 6.River basin:Yadkin
7.Approximate drainage area: 25 acres 8. Stream order:.First Order
9.Length of reach evaluated:93 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.134176 Longitude(ex.-77.55661 t): -80.122372
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated north of W Mountain St between Loflin Concrete and Cash Elementary School
14.Proposed channel work(if any): None
15.Recent weather conditions: MOStIy sunny and cool with —0.01" of rain the night prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed.iv (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: _%Residential 85 %Commercial _%Industrial _%Agricultural
15 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width:5' 23.Bank height(from bed to top of bank):4'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: _zStraight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 32 Comments:
Stream SP is a perennial feature that begins at a culvert outlet that drains multiple wash bays at a large industrial concrete
mixing plant. The stream is incised and has little woody riparian vegetation within the project study area. The grass is
mowed/maintained up to the stream banks.
Evaluator's Signature Yu1116u-am, Date 01/28/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SP
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 0-5 0-5 1
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 0
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 1
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 2
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 0
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 0
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 2
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 1
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 2
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 2
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 1
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 0
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 2
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5 0
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 32
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form, Version 4.11
Date: 2/2/2016 Project/Site: TIP U-5760 Latitude: 36.134117
Stream SR
Evaluator: R.Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115122
Kimley-Horn
Total Points: 19.5 Stream Deter n (circle one) Other
Stream is at least intermittent Ephemer Intermitten erennial e.g.Quad Name: Belews Creek
if>19 or perennial if>_30
A. Geomorphology Subtotal = 7.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 2
2. Sinuosity of channel along thalweg 0 1 2 3 1
3. In-channel structure: ex. riffle-pool, step-pool,
ripple-pool sequence 0 1 2 3 1
4. Particle size of stream substrate 0 1 2 3 1
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1.5
10. Natural valley 0 0.5 1 1.5 0
11. Second or greater order channel No = 0 Yes = 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 8
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 2
14. Leaf litter 1.5 1 0.5 0 0
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 0.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = 4
18. Fibrous roots in streambed 3 2 1 0 1
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SR is a short, weak intermittent stream that crosses a
utility easement. The water in the feature appears to be artificially perched by
the utility easement construction.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:02/02/2016 4.Time of evaluation: 10:30 am
5.Name of stream:Stream SR 6.River basin:Yadkin
7.Approximate drainage area: 3 acres 8. Stream order:.First Order
9.Length of reach evaluated: 37 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.134117 Longitude(ex.-77.55661 t): -80.115122
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated south of NC 66 and west of Stanley Farm Rd
14.Proposed channel work(if any): None
15.Recent weather conditions:The area received 0.03" the day prior to the site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? NO
21. Estimated watershed land use: 25 %Residential _%Commercial _%Industrial _%Agricultural
75 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width:4' 23.Bank height(from bed to top of bank): 0.5'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: _zStraight Occasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 30 Comments:
Stream SR is a short, weak intermittent stream that crosses a utility easement. The water in the feature appears to be
artificially Qerched by the utility easement construction.
Evaluator's Signature Yu1116u-am, Date 02/02/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change-version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SR
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 3
Evidence of past human alteration
2 0-6 0-5 0-5 O
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 1
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 0
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 2
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 0
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 0
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
� 12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 0
E* Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 3
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 0
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 1
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 1
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 2
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5 0
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 30
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 2/2/2016 Project/Site: TIP U-5760 Latitude: 36.128624
Stream SS
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.115093
Kimley-Horn
Total Points: 35 Stream Determination (circle one) Other
Stream is at least intermittent Ephemeral Intermitte erennia g.Quad Name: Belews Creek
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 19 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 2
poolsequence
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 2
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or greater order channel No = 0 Yes= 3 3
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 2
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 1
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SS is a meandering perennial stream in a natural topographic
crenulation. The upper reach of SS has multiple headcuts with strong flow. The
stream goes underground in several locations.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:02/02/2016 4.Time of evaluation: 1:00 pm
5.Name of stream:Stream SS 6.River basin:Yadkin
7.Approximate drainage area: 59 acres 8. Stream order:.Second Order
9.Length of reach evaluated: 2,400 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.128624 Longitude(ex.—77.556611): -80.115093
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated from its origin just south of NC 66 to its confluence with Kerners Mill Creek
14.Proposed channel work(if any): None
15.Recent weather conditions:The area received 0.03" the day prior to the site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? YES 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 60%Residential _%Commercial _%Industrial _%Agricultural
40 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width:3' 23.Bank height(from bed to top of bank): 3'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends ✓Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 58 Comments:
Stream SS is a meandering perennial stream in a natural topographic crenulation. The upper reach of SS has multiple headcuts
with strong flow. The stream goes underground in several locations.
Evaluator's Signature Yu1116u-am, Date 02/02/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SS
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 0-5 0-5 2
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 4
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 0
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 3
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 3
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
� 12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 2
E* Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 3
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 4
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 3
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 3
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 3
18 Canopy coverage over streambed 0—5 0—5 0—5 3
no shadingvegetation=0; continuous canopy=max points)
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5 0
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 1
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 3
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 58
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form, Version 4.11
Date: 2/2/2016 Project/Site: TIP U-5760 Latitude: 36.133520
Stream ST
Evaluator: R.Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115512
Kimley-Horn
Total Points: 31.5 Stream Determination a Other
Stream is at least intermittent Ephemeral Intermitt nt Perennial e.g.Quad Name: Belews Creek
if>19 or perennial if>_30
A. Geomorphology Subtotal = 17 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool,
ripple-pool sequence 0 1 2 3 2
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or greater order channel No = 0 Yes = 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 9.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = 5
18. Fibrous roots in streambed 3 2 1 0 2
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream ST is a weak perennial channel fed by multiple groundwater
seeps. ST has moderate flow with shallow water over silt/sand that was likely
eroded from the surrounding hills. Drains to stream SS at a headcut.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:02/02/2016 4.Time of evaluation: 2:30 pm
5.Name of stream:Stream ST 6.River basin:Yadkin
7.Approximate drainage area: 2 acres 8. Stream order:.First Order
9.Length of reach evaluated:92 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.133520 Longitude(ex.-77.55661 t): -80.115512
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated from its origin south of NC 66 to its confluence with stream SS
14.Proposed channel work(if any): None
15.Recent weather conditions:The area received 0.03" the day prior to the site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? NO
21. Estimated watershed land use: 55 %Residential _%Commercial _%Industrial _%Agricultural
45 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width: 12' 23.Bank height(from bed to top of bank): 5'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: _zStraight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 56 Comments:
Stream ST is a weak perennial channel fed by multiple groundwater seeps. ST has moderate flow with shallow water over
silt/sand that was likely eroded from the surrounding hills. Drains to stream SS at a headcut.
Evaluator's Signature Yu1116u-am, Date 02/02/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream ST
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 o-s o-s 4
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 4
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 1
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 2
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 2
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
� 12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 2
E* Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 3
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 3
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 3
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 3
18 Canopy coverage over streambed 0—5 0—5 0—5 5
no shadingvegetation=0; continuous canopy=max points)
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 0-4 0-5 0-5
(no evidence=0; common,numerous types=max points)
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 56
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form, Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.133190
Stream SU
Evaluator: R.Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115396
Kimley-Horn
Total Points: 21 Stream Determ tion (circle one) Other
Stream is at least intermittent Ephemera ntermitte Perennial e.g.Quad Name: Belews Creek
if>19 or perennial if>_30
A. Geomorphology Subtotal = 10.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 1
2. Sinuosity of channel along thalweg 0 1 2 3 2
3. In-channel structure: ex. riffle-pool, step-pool,
ripple-pool sequence 0 1 2 3 2
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 0
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or greater order channel No = 0 Yes = 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 7.5
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 0.5
15. Sediment on plants or debris 0 0.5 1 1.5 1
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = 3
18. Fibrous roots in streambed 3 2 1 0 1
19. Rooted upland plants in streambed 3 2 1 0 2
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SU is a weak intermittent stream that begins at a headcut
and drains to stream SS at a headcut. SU has low flow, but is in a washed
channel. SU goes underground before reaching SS. Channel bottom has good
substrate sorting. SU crosses a utility easement before the confluence with
SS and loses some bed/bank definition but the primary flow path and OHWM
are maintained.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:02/02/2016 4.Time of evaluation: 3:00 pm
5.Name of stream:Stream SU 6.River basin:Yadkin
7.Approximate drainage area: 2 acres 8. Stream order:.First Order
9.Length of reach evaluated: 131 1 i nea r feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.133190 Longitude(ex.-77.556611): -80.115396
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated from its origin south of NC 66 to its confluence with stream SS
14.Proposed channel work(if any): None
15.Recent weather conditions:The area received 0.03" the day prior to the site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 55 %Residential _%Commercial _%Industrial _%Agricultural
45 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width:4' 23.Bank height(from bed to top of bank): 1
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: _zStraight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 50 Comments:
Stream SU is a weak intermittent stream that begins at a headcut and drains to stream SS at a headcut. SU has low flow, but
is in a washed channel. SU goes underground before reaching SS. Channel bottom has good substrate sorting. SU crosses a
utility easement before the confluence with SS and loses some bed/bank definition but the primary flow path and OHWM are
maintained.
Evaluator's Signature °' �``�`"a r' Date 02/02/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SU
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 3
Evidence of past human alteration
2 0-6 o-s o-s 3
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2
1
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 2
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 Q
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 2
11 Size&diversity of channel bed substrate NA* 0-4 0-5 2
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 3
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 3
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 3
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 3
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 3
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 4
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 50
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.124209
Stream SV
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.112811
Kimley-Horn
Total Points: 44 Stream Determination (�erennial
Other Belews Creek&
Stream is at least intermittent Ephemeral Intermittene.g.quad Name: Kernersville
if>_19 or perennial if 2:30
A. Geomorphology Subtotal = 26.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 2
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 3
8. Headcuts 0 1 2 3 2
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1
11. Second or greater order channel No = 0 Yes= 3 3
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 11.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 1.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SV is a perennial channel in a natural topographic valley. SV
begins at a stormwater pipe outlet and is severely incised at the top of reach
(-15'). The lower reaches are more stabilized, but there is significant sediment
deposition along the entire stream.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:02/02/2016 4.Time of evaluation:4:00 pm
5.Name of stream:Stream SV 6.River basin:Yadkin
7.Approximate drainage area:60 acres 8. Stream order:.Second Order
9.Length of reach evaluated: 1,990 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.124209 Longitude(ex.-77.556611): -80.112811
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated west of Hopkins Rd from pipe outlet north of Copperfield Ct to the confluence with Kerners Mill Creek
14.Proposed channel work(if any): None
15.Recent weather conditions:The area received 0.03" the day prior to the site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 70%Residential _%Commercial _%Industrial _%Agricultural
30 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width:6-8' 23.Bank height(from bed to top of bank): 3-5'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends ✓Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 50 Comments:
Stream SV is a perennial channel in a natural topographic valley. SV begins at a stormwater pipe outlet and is severely incised
at the top of reach (-15). The lower reaches are more stabilized, but there is significant sediment deposition along the entire
stream.
Evaluator's Signature °' �``�`"a r' Date 02/02/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SV
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS SCORE
Coastal Piedmont Mountain
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 0-5 0-5 2
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 3
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 3
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 1
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 Q
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 1
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
� 12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 Q
E* Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 2
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 3
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 3
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 4
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 0-4 0-5 0-5
(no evidence=0; common,numerous types=max points)
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 2
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 50
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.123613
Stream SW
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.112908
Kimley-Horn
Total Points: 38.5 Stream Determination (�erennial
Other
Stream is at least intermittent Ephemeral Intermittene.g.quad Name: Kernersville
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 22.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 2
8. Headcuts 0 1 2 3 3
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1
11. Second or greater order channel No = 0 Yes= 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SW is a perennial channel that begins at a stormwater drop
inlet. Erosion/bank failures are present throughout the reach and severe
sediment build-up/deposition was observed within the reach.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:02/02/2016 4.Time of evaluation:4:45 pm
5.Name of stream:Stream SW 6.River basin:Yadkin
7.Approximate drainage area: 12 acres 8. Stream order:.First Order
9.Length of reach evaluated: 352 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.123613 Longitude(ex.-77.556611): -80.112908
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
The reach was evaluated between Hopkins Rd and Savannah Ct
14.Proposed channel work(if any): None
15.Recent weather conditions:The area received 0.03" of rain the day prior to the site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 60%Residential _%Commercial _%Industrial _%Agricultural
40 %Forested _%Cleared/Logged _%Other( 1
22.Bankfull width:4' 23.Bank height(from bed to top of bank): 2'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) F Steep(>10%)
25.Channel sinuosity: Straight 00ccasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 49 Comments:
Stream SW is a perennial channel that begins at a stormwater drop inlet. Erosion/bank failures are present throughout the
reach and severe sediment build-up/deposition was observed within the reach.
Evaluator's Signature Yu1116u-am, Date 02/02/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SW
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 3
Evidence of past human alteration
2 0-6 o-s o-s 3
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 4
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 3
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 3
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 1
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 2
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 Q
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 3
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 1
11 Size&diversity of channel bed substrate NA* 0-4 0-5 2
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 2
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 2
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 4
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 3
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 4
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 2
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 49
* These characteristics are not assessed in coastal streams.
2

North Carolina Division of Water Quality-Stream Identification Form,Version 4.11
Date: 2/8/2016 Project/Site: TIP U-5760 Latitude: 36.109392
Stream SX
Evaluator: R.Sullivan/J.Hartshorn County: Forsyth Longitude: -80.090296
Kimley-Horn
Total Points: 25.5 Stream Deter (circle one) Other
Stream is at least intermittent Ephemera ntermittent erennial e.g.Quad Name: Kernersville
if>_19 or perennial if>_30
A. Geomorphology Subtotal = 9 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 0
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 1
poolsequence
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or greater order channel No = 0 Yes= 3 0
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal = 10.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 3
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0
16. Organic debris lines or piles 0 0.5 1 1.5 0.5
17. Soil-based evidence of high water table? No = 0 Yes= 3 3
C. Biology Subtotal = 6
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed F FACW = 0.75; OBL= 1.5; Other= 0 0
'perennial streams may also be identified using other methods. See p.35 of manual.
Notes: Stream SX is an intermittent stream channel that is mostly piped and
only daylights within the project corridor for-47'. The channel is linear. There
was strong flow during the site visit.

USACE AID# DWQ# Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -AQF
Provide the following information for the stream reach under assessment:
1.Applicant's name:NCDOT 2.Evaluator's name: R. Sullivan/1 Hartshorn (Kimley-Horn)
3.Date of evaluation:02/08/2016 4.Time of evaluation: 5:30 pm
5.Name of stream:Stream SX 6.River basin:Yadkin
7.Approximate drainage area: 32 acres 8. Stream order:.First Order
9.Length of reach evaluated:47 linear feet 10.County: Forsyth
11. Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): N/A
Latitude(ex.34.872312): 36.109392 Longitude(ex.-77.55661 t): -80.090296
Method location determined(circle): ✓❑-BPS ✓aopo Sheet ✓� rtho(Aerial)Photo/GIS❑Dther GISather
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
Stream SX daylights in the corridor for 47 just south of Business 140 and north of Arbor Hill Rd
14.Proposed channel work(if any): None
15.Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. Site conditions at time of visit: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classifications known: FISection 10 FITidal Waters Essential Fisheries Habitat
nTrout Waters 00utstanding Resource Waters EJ Nutrient Sensitive Waters Dwater Supply Watershed III (I-IV)
18.is there a pond or lake located upstream of the evaluation point? NO If yes,estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20.Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: _%Residential 85 %Commercial _%Industrial _%Agricultural
5 %Forested _%Cleared/Logged 10%Other(Paved Road
22.Bankfull width: 10' 23.Bank height(from bed to top of bank):4'
24.Channel slope down center of stream: Flat(0 to 2%) Gentle(2 to 4%) Moderate(4 to 10%) Steep(>10%)
25.Channel sinuosity: _zStraight Occasional bends Frequent meander Overy sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 25 Comments:
Stream SX is an intermittent stream channel that is mostly piped and only daylights within the project corridor for- 47'. The
channel is linear.
Evaluator's Signature °' �``�`"a r' Date 02/08/2016
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change-version 06/03. To Comment,please call 919-876-8441 x 26.
1

Stream SX
STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS SCORE
Coastal Piedmont Mountain
Presence of flow/persistent pools in stream
1 (no flow or saturation=0; strong flow=max points) 0-5 0-4 0-5 4
Evidence of past human alteration
2 0-6 0-5 0-5 O
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0-6 0-4 0-5 0
no buffer=0; contiguous,wide buffer=maxpoints)
Evidence of nutrient or chemical discharges
4 0-5 0-4 0-4 2
(extensive discharges=0;no discharges=max points)
a Groundwater discharge
U 5 no discharge=0• springs,sees wetlands etc.=max points)
0-3 0-4 0-4 2
( g p > p )
Presence of adjacent floodplain
6 (no floodplain=0;extensive floodplain=max points) 0-4 0-4 0-2 0
Ox. Entrenchment/floodplain access 0—5 0—4 0—2 0
(deeply entrenched=0;frequent flooding=max points)
Presence of adjacent wetlands
8 no wetlands=0;large adjacent wetlands=maxpoints) 0-6 0-4 0-2 0
Channel sinuosity
9 extensive channelization=0;natural meander=maxpoints) 0-5 0-4 0-3 0
Sediment input
10 (extensive deposition=0;little or no sediment=max points) 0 5 0 4 0 4 1
11 Size&diversity of channel bed substrate NA* 0-4 0-5 3
(fine,homogenous=0;large, diverse sizes=max points)
Evidence of channel incision or widening
12 (deeply incised=0; stable bed&banks=max points) 0 5 0 4 0 5 1
Presence of major bank failures
� 13 (severe erosion=0;no erosion, stable banks=max points) 0-5 0-5 0-5 3
Root depth and density on banks
14 no visible roots=0;dense roots throughout=maxpoints) 0-3 0-4 0-5 3
E�
J1 Impact by agriculture, livestock,or timber production
15 substantial impact=0;no evidence=maxpoints) 0-5 0-4 0-5 0
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6 1
no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity
17 (little or no habitat=0;frequent,varied habitats=max points) 0 6 0 6 0 6 0
Canopy coverage over streambed
x
18 no shading vegetation=0; continuous canopy=maxpoints) 0-5 0-5 0-5 2
19 Substrate embeddedness NA* 0-4 0-4 3
(deeply embedded=0;loose structure=max
Presence of stream invertebrates(see page 4)
20 (no evidence=0; common,numerous types=max points) 0-4 0-5 0-5 0
21 Presence of amphibians 0-4 0-4 0-4 0
O (no evidence=0; common,numerous types=max points)
O 22 Presence of fish 0 4 0 4 0 4 0
(no evidence=0; common,numerous types=max points)
23 Evidence of wildlife use 0-6 0-5 0-5 0
(no evidence=0;abundant evidence=max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) 25
* These characteristics are not assessed in coastal streams.
2

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/26/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WA-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Levee Local relief(concave,convex,none): Convex Slope(%): <1%
Subregion(LRR or MLRA): LRR P Lat: 36.107350 Long: -80.106666 Datum: NAD 83
Soil Map Unit Name: Dan River loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No IZI
Wetland Hydrology Present? Yes_ _ No ✓
Remarks:
WA-UP is located —45' south of and V higher in elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >30"
Saturation Present? Yes= Non Depth(inches): >30" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WA-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer negundo 25% Y FAC That Are OBL, FACW,or FAC: 5 (A)
2.Sycamore occidentalis 15% Y FACW
Total Number of Dominant
3.Acer rubrum 5% N FAC Species Across All Strata: 9 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 55.6% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
45% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Acer negundo 20% Y FAC FAC species x 3=
2.Prunus serotina 10% Y FACU FACU species x 4=
3.Ligustrum sinense 10% Y FACU UPL species x 5=
4.Rosa multiflora 5% N FACU Column Totals: (A) (B)
5.Juniperus virginiana 5% N
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
50% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 40% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.Rubus argutus 20% Y FACU
3.Allium canadense 10% N FACU 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
70% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Lonicera.japonica 10% Y FAC height.
2.Hedera helix 10% Y FACU
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
20% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The data point was taken on the edge of easement on landward side of the stream levee.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WA-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-3" 7.5YR 2.5/3 100% Loam
3-20" 7.5YR 4/4 100% Loam
20-30" 7.5YR 4/4 100% Loamy clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
No indicators of wetland soil observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/26/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WA-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Stream floodplain Local relief(concave,convex,none): None Slope(%): <1%
Subregion(LRR or MLRA): LRR P Lat: 36.107477 Long: -80.106633 Datum: NAD 83
Soil Map Unit Name: Dan River loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� Non (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetland WA is a stream floodplain wetland adjacent to Smith Creek. WA is partially within a maintained
sewer/stormwater easement and is supported hydrologically by seepage from upslope stormwater pond.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) ✓ Drainage Patterns(610)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) ✓ Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
✓ Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑✓ Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
✓ Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes FLL No Depth(inches): 0-6
Water Table Present? Yes n✓ _ No-4 Depth(inches): Surface
Saturation Present? Yes i v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No n
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
Saturated soils and the water table were both observed at the surface. Dense algae was observed
in pools of standing water. The area is likely frequently flooded and receives seepage from adjacent
hillslope and stormwater pond.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WA-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.None That Are OBL, FACW,or FAC: 6 (A)
2. Total Number of Dominant
3• Species Across All Strata: 7 (B)
4.
Percent of Dominant Species 85 7%
5. That Are OBL, FACW,or FAC: (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
=Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Acer rubrum 5% Y FAC FAC species x 3=
2.Liquidambar styraciflua 5% Y FAC FACU species x 4=
3.Fraxinus pennsylvanica 5% Y FACW UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
15% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Festuca sp. 40% Y FACU _ Problematic Hydrophytic Vegetation' (Explain)
2.Juncus effusus 20% Y FACW
3. Cyperus strigosus 20% Y FACW 'Indicators of hydric soil and wetland hydrology must
4.Solidago sp. 5% N NI be present, unless disturbed or problematic.
5.Rubus argutus 5% N FACU Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12. of size,and woody plants less than 3.28 ft tall.
90% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Lonicera.japonica 10% Y FAC height.
2.
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
10% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The data point is in a frequently maintained utility easement.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WA-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-7" 10YR 5/2 85% 7.5YR 5/6 15% C M Sandy clay
7-14" 10YR 3/1 90% 10YR 5/6 10% C M Clay gravelly
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
The water table and soil saturation was present at the surface. Below 14" the soils were too
rocky/packed for removal/analysis.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/26/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WB-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Stream levee Local relief(concave,convex,none): Convex Slope(%): <1%
Subregion(LRR or MLRA): LRR P Lat: 36.110878 Long: -80.113323 Datum: NAD 83
Soil Map Unit Name: Hatboro loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No v
Wetland Hydrology Present? Yes_ _ No ✓
Remarks:
WB-UP is a natural levee between WB and SE.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >30"
Saturation Present? Yes= Non Depth(inches): 30" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)—Use scientific names of plants. Sampling Point: WB-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1•Fagus grandifolia 30% Y FACU That Are OBL, FACW,or FAC: 5 (A)
2.Acer rubrum 30% Y FAC
Total Number of Dominant
3.Liquidambar styraciflua 30% Y FAC Species Across All Strata: 8 (B)
4•Fraxinus pennsylvanica 10% N FACW
Percent of Dominant Species
5 That Are OBL, FACW,or FAC: 62.5% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
100% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Quercus phellos 5% Y FAC FAC species x 3=
2•Juniperus virginiana 5% Y FACU FACU species x 4=
3. UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
10% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 60% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.Andropogon virginicus 30% Y FACU
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree—Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub—Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb—All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
90% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine—All woody vines greater than 3.28 ft in
1.Lonicera.japonica 5% Y FAC height.
2.
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
5% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

SOIL Sampling Point:WB-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-14" 10YR 4/3 100% Loam
14-30" 10YR 4/4 100% Sandy loam
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) ❑ Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
No hyrdric soil indicators present at the upland data point. The sand increases with depth. Neither
the water table nor soil saturation was observed within 30".
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/26/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WB-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Bottomland Local relief(concave,convex,none): Concave Slope(%): <1%
Subregion(LRR or MLRA): LRR P Lat: 36.110860 Long: -80.113372 Datum: NAD 83
Soil Map Unit Name: Hatboro loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� Non (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetland WB is a bottomland wetland associated with Smith Creek. The wetland also appears to
receive seepage from adjacent fishery ponds.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) ✓ Drainage Patterns(610)
✓ Saturation (A3) ✓ Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) ✓ Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
✓ Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑✓ Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes FLL No Depth(inches): 1 -4
11
Water Table Present? Yes 0�_ No ✓ Depth(inches): >30"
v l Saturation Present? Yes i Non Depth(inches): Surface Wetland Hydrology Present? Yes M No n
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
WB receives hydrology from water seeping through the adjacent fishery pond berms and whenever
Smith Creek floods. Standing water was observed throughout the wetland, however the wetland
data point was taken on a slight hummock.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)—Use scientific names of plants. Sampling Point: WB-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Salix nigra 15% Y OBL That Are OBL, FACW,or FAC: 5 (A)
2.Acer rubrum 10% Y FAC
Total Number of Dominant
3• Species Across All Strata: 5 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 100% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
25% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1•Alnus serrulata 20% Y OBL FAC species x 3=
2.Acer rubrum 20% Y FAC FACU species x 4=
3.Fraxinus pennsylvanica 10% N FACW UPL species x 5=
4•Liquidambar styraciflua 5% N FAC Column Totals: (A) (B)
5.Salix nigra 5% N OBL
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
60% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 70% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.Juncus effusus 15% N FACW
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree—Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub—Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb—All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
85% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine—All woody vines greater than 3.28 ft in
1.None height.
2.
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
=Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

SOIL Sampling Point:WB-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-10" 7.5YR 6/1 60% 7.5YR 5/6 40% C PL Sandy clay
10-15" 7.5YR 5/2 70% 5YR 5/4 30% C M Loamy sand
15-30" 7.5YR 5/1 60% 7.5YR 4/6 40% C PL Clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
The soil is saturated at the surface. The soil had a depleted matrix.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/27/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WD-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Hillslope Local relief(concave,convex,none): None Slope(%): 4-6%
Subregion(LRR or MLRA): LRR P Lat: 36.111523 Long: -80.113006 Datum: NAD 83
Soil Map Unit Name: Hatboro loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No IZI
Wetland Hydrology Present? Yes_ No ✓
Remarks:
WD-UP is on a hillslope above wetland WD. The upland data point is 15' east of and 3' higher in
elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >30"
Saturation Present? Yes= Non Depth(inches): >30" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No wetland hydrology indicators observed at the upland data point. Groundwater appears to move
through the soil profile above a restrictive layer at 7", but not a sufficient duration to create a
hydrology indicator.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)—Use scientific names of plants. Sampling Point: WD-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Liriodendron tulipifera 30% Y FACU That Are OBL, FACW,or FAC: 6 (A)
2.Acer rubrum 30% Y FAC
Total Number of Dominant
3.Platanus occidentalis 30% Y FACW Species Across All Strata: 8 (B)
4•Liquidambar styraciflua 10% N FAC
Percent of Dominant Species o
5 That Are OBL, FACW,or FAC: 75/0 (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
100% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1•Acer rubrum 20% Y FAC FAC species x 3=
2•Liriodendron tulipifera 15% Y FACU FACU species x 4=
3.Fraxinus pennsylvanica 10% N FACW UPL species x 5=
4•Liquidambar styraciflua 10% N FAC Column Totals: (A) (B)
5.Rosa multiflora 5% N FACU
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
60% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Rubus argutus 5% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree—Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub—Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb—All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
5% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine—All woody vines greater than 3.28 ft in
1.Lonicera.japonica 5% Y FAC height.
2.Vitis rotundifolia 5% Y FAC
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
10% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

SOIL Sampling Point:WD-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
041 7.5YR 3/3 100% Loam
4-7" 7.5YR 3/1 85% 7.5YR 5/6 15% C M Loam
7-20" 10YR 5/2 85% 7.5YR 5/6 15% C M Loamy clay
20-30" 7.5YR 6/5 100% Loamy clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
Soil has a tight clay layer at 7" that is holding water close to the surface when it seeps down the
hillslope creating concentrations. However, no concentrations were observed along the pore linings
and the soils were bright above and below the restrictive layer.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/27/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WD-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Bottomland floodplain Local relief(concave,convex,none): None Slope(%): 1%
Subregion(LRR or MLRA): LRR P Lat: 36.111527 Long: -80.113057 Datum: NAD 83
Soil Map Unit Name: Hatboro loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� Non (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetland WD is a bottomland wetland that ponds stormwater and floods with Smith Creek. Surface water
was observed in the wetland to a depth of 6", and a ditch has been cut along the boundary near Smith
Creek.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
✓ Saturation (A3) ✓ Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) ✓ Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑✓ Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes ✓ No Depth(inches): 0-6
Water Table Present? Yes n✓ _ No-4 Depth(inches): Surface
Saturation Present? Yes i v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No n
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
WD-WET is on a very slight hillslope on the eastern edge of wetland WD. The wetland ponds water
from precipitation and flooding from Smith Creek.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WD-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer rubrum 60% Y FAC That Are OBL, FACW,or FAC: 6 (A)
2.Liriodendron tulipifera 15% N FACU Total Number of Dominant
3.Platanus occidentalis 10% N FACW Species Across All Strata: 7 (B)
4.
Percent of Dominant Species 85 7%
5. That Are OBL, FACW,or FAC: (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
85% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Rosa multiflora 10% Y FACU FAC species x 3=
2.Liquidambar styraciflua 5% Y FAC FACU species x 4=
3.Acer rubrum 5% Y FAC UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
20% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 30% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
30% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Lonicera.japonica 5% Y FAC height.
2.Smilax rotundifolia 5% Y FAC
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
10% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Light understory observed within the wetland. Vegetation was concentrated on hummocks within the wetland.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WD-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-Y 10YR 4/1 90% 10YR 3/4 10% C M Loamy clay
3-20" 10YR 6/2 90% 7.5YR 5/6 10% C M Sandy clay
20-30" 10YR 5/1 95% 10YR 5/6 5% C M Sandy clay loam
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF 1 Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
Both saturation and the water table was observed at the surface. No surface water observed at the
data point but was observed throughout much of the wetland's interior.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/28/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WE-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Hillslope Local relief(concave,convex,none): Convex Slope(%): 5%
Subregion(LRR or MLRA): LRR P Lat: 36.113924 Long: -80.124960 Datum: NAD 83
Soil Map Unit Name: Fairview fine sandy loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes _ No ✓
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No IZI
Wetland Hydrology Present? Yes_ No ✓
Remarks:
WE-UP is approximately 40' east of and 3' higher in elevation than the wetland data point location
and is situated on a hillslope.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >30"
Saturation Present? Yes= Non Depth(inches): >30" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WE-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Liriodendron tulipifera 35% Y FACU That Are OBL, FACW,or FAC: 3 (A)
2.Quercus alba 25% Y FACU Total Number of Dominant
3.Oxydendrum arboreum 15% N UPL Species Across All Strata: 7 (B)
4•Carya tomentosa 15% N UPL
Percent of Dominant Species
5.-
That Are OBL, FACW,or FAC: 42'9% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
90% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Carya tomentosa 10% Y UPL FAC species 15 x 3=45
2•Carpinus caroliniana 5% Y FAC FACU species 65 x 4= 260
3•Cornus. lorida 5% Y FACU UPL species 40 x 5= 200
4. Column Totals: 120 (A) 505 (B)
5.
Prevalence Index =B/A= 4.2
6.
7 Hydrophytic Vegetation Indicators:
1 -Rapid Test for Hydrophytic Vegetation
8.
2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
20% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.None Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
=Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Smilax rotundifolia 5% Y FAC height.
2.Lonicera iaponica 5% Y FAC
3.
4.
5 Hydrophytic
VegetationF1
6• Present? Yes No
10% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WE-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
04" 10YR 3/3 100% Loam
4-24" 10YR 4/6 100% Clay loam
24-30" 7.5YR 5/6 100% Clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF 1 Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
No hydric soil indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/28/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WE-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Depressional wetland Local relief(concave,convex,none): Concave Slope(%): 1-2%
Subregion(LRR or MLRA): LRR P Lat: 36.113970 Long: -80.125040 Datum: NAD 83
Soil Map Unit Name: Fairview fine sandy loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� Non (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetland WE is a depressional wetland that was previously connected to a large fish hatchery pond by a
buried pipe. WE appears to have been historically dugout, with one of the side slopes having partially
buried trash and appears to have been used as a trash dump historically.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) ✓ Drainage Patterns(610)
✓ Saturation (A3) ✓ Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
✓ Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑✓ Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
✓ Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes FLL No Depth(inches): 1-2
Water Table Present? Yes n✓ _ No-4 Depth(inches): 2"
Saturation Present? Yes i v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No n
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
Hydrology is primarily from groundwater and overland flow during precipitation events. Standing
water was observed in the wetland to a depth of 2".
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WE-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer rubrum 30% Y FAC That Are OBL, FACW,or FAC: 9 (A)
2.Fraxinus pennsylvanica 25% Y FACW
Total Number of Dominant
3.Carpinus caroliniana 10% N FAC Species Across All Strata: 9 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 100% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
65% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1. Viburnum dentatum 15% Y FAC FAC species x 3=
2.Acer rubrum 10% Y FAC FACU species x 4=
3,Carpinus caroliniana 5% Y FAC UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
30% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 30% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2. Carex sp. 15% Y FAC
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
45% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Lonicera.japonica 5% Y FAC height.
2.Smilax rotundifolia 5% Y FAC
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
10% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WE-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-2" 10YR 2/2 100% Loam
2-14" 2.5Y 6/2 95% 7.5YR 4/4 5% C PL Sandy loam
14-30" 7.5YR 5/6 90% 10YR 6/2 10% D M Clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) ❑ Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
✓ Depleted Below Dark Surface(A11) ✓ Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No E]_
Remarks:
The soil was saturated at the surface with the water table beginning at N 1-2".
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/28/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WF-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Bottomland Local relief concave,convex,none): Concave Sloe % 1%
Landform(hillslope,terrace,etc.): ( ) p ( ):
Subregion(LRR or MLRA): LRR P Lat: 36.125470 Long: -80.112010 Datum: NAD 83
Soil Map Unit Name: Fairview clay loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No IZI
Wetland Hydrology Present? Yes— _ No ✓
Remarks:
WF-UP is in a bottomland that has been altered by ditching to carry drainage away from a
pool/recreational field positioned below a large pond. The upland data point is —15' west of and 1' higher
in elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes EL No y I I_ Depth(inches):
Water Table Present? Yes 2✓ _ No IL�IL Depth(inches): 14"
Saturation Present? Yes I v l Non Depth(inches): 14" Wetland Hydrology Present? Yes El No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point. Seasonal high water
table was observed at 14".
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WF-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Liriodendron tulipifera 40% Y FACU That Are OBL, FACW,or FAC: 5 (A)
2.Acer rubrum 20% Y FAC
Total Number of Dominant
3 Pinus virginiana 20% Y NI Species Across All Strata: 9 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 55.6% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
80% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Ilex vomitoria 20% Y FAC FAC species x 3=
2.Juniperus virginiana 5% Y FACU FACU species x 4=
3.Liquidambar styraciflua 5% Y FAC UPL species x 5=
4.Acer rubrum 5% Y FAC Column Totals: (A) (B)
5.Ilex opaca 5% Y FACU
6.Rosa multiflora 5% Y FACU Prevalence Index =B/A=
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
45% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.None Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
=Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Vitis rotundifolia 5% Y FAC height.
2.
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
5% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WF-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-14" 2.5Y 5/6 100% Sandy clay
14-24" 10YR 6/6 90% 10YR 7/1 10% D M Sandy clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) ❑ Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
The soil was a tight clay and could not auger below 24". Neither saturation or the water table was
observed within 24" of the soil profile. Depletions increased with depth.
No indicators of hydric soil was observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/28/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WF-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Bottomland Local relief(concave,convex,none): Concave Slope(%): 1%
Subregion(LRR or MLRA): LRR P Lat: 36.125468 Long: -80.111987 Datum: NAD 83
Soil Map Unit Name: Fairview clay loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� Non (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetland WF is a bottomland wetland below a large pond. Stream SN runs along the outer edge of WE It
appears that SN has been historically ditched, likely to direct water/seepage away from adjacent
pool/recreational area.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) ✓ Drainage Patterns(610)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) ✓ Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
✓ Iron Deposits(135) ❑✓ Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
✓ Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes ✓ No Depth(inches): 0-2
Water Table Present? Yes n✓ _ No-4 Depth(inches): Surface
Saturation Present? Yes i v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No n
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
WF-WET is within a low drainage pattern in WE Iron oxidizing bacteria and iron deposits are
present throughout the wetland and surface water. The primary wetland hydrology inputs appear to
be from groundwater seepage from the upslope pond.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WF-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Liriodendron tulipifera 100/0 Y FACU That Are OBL, FACW,or FAC: 3 (A)
2.Liquidambar styraciflua 10% Y FAC
Total Number of Dominant
3.Acer rubrum 10% Y FAC Species Across All Strata: 5 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 60% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
30% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Ilex vomitoria 25% Y FAC FAC species x 3=
2.Rosa multiflora 15% Y FACU FACU species x 4=
3. UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
40% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.None Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
=Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.None height.
2.
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
=Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Yaupon holly dominates the wetland area. It was likely planted as an ornamental and has naturalized in the natural
areas. Sparse vegetation was observed within much of the inundated portions of the wetland.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WF-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-3" 2.5Y 5/2 100% Loam
3-8" 2.5Y 6/1 70% 2.5Y 6/6 30% C M Clay
8-24" 2.5Y 6/1 85% 2.5Y 6/6 15% C M Clay loam
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No 0-
Remarks:
The water table and soil saturation was observed at the surface.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/28/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WG/WH-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Hillslope Local relief(concave,convex,none): None Slope(%): 1-2%
Subregion(LRR or MLRA): LRR P Lat: 36.134305 Long: -80.122574 Datum: NAD 83
Soil Map Unit Name: Nathalie sandy loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes _ No ✓
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No IZI
Wetland Hydrology Present? Yes_ _ No ✓
Remarks:
The upland data point is —30' west of and 0.5' higher in elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >30"
Saturation Present? Yes= Non Depth(inches): >30" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WG/WH-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer rubrum 25% Y FAC That Are OBL, FACW,or FAC: 2 (A)
2. Total Number of Dominant
3• Species Across All Strata: 4 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 50% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
25% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1•Ligustrum sinense 15% Y FACU FAC species 35% x 3= 105
2. FACU species 70% x 4= 280
3. UPL species x 5=
4. Column Totals: 105 (A) 385 (B)
5.
Prevalence Index =B/A= 3.67
6.
7 Hydrophytic Vegetation Indicators:
1 -Rapid Test for Hydrophytic Vegetation
8.
2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
15% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Digitaria sanguinalis 50% Y FACU _ Problematic Hydrophytic Vegetation' (Explain)
2.Allium canadensis 5% N FACU
3. Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12. of size,and woody plants less than 3.28 ft tall.
55% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Toxicodendron radicans 10% Y FAC height.
2.
3.
4.
5 Hydrophytic
VegetationF1
6• Present? Yes No
10% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The upland area lacks the wetland vegetation that is present in the seep areas.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WG/WH-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-30" 7.5YR 4/6 100% Sandy clay loam
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF 1 Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
No hydric soil indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 1/28/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WG/WH-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Hillslope seep Local relief(concave,convex,none): None Slope(%): 2%
Subregion(LRR or MLRA): LRR P Lat: 36.134315 Long: -80.122465 Datum: NAD 83
Soil Map Unit Name: Nathalie sandy loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetlands WG and WH are seep wetlands on each side of stream SP. There are several large truck "wash
bays" and associated water retention ponds that slowly seep water downslope to the wetlands and
stream.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
✓ Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes I v l No Depth(inches): 1
Water Table Present? Yes 2✓ _ No-4 Depth(inches): Surface
Saturation Present? Yes i v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
The water table and soil saturation was observed at the surface. The hillside seeps are primarily fed
hydrology from active truck washing stations upslope at concrete plant. Iron oxidizing bacteria was
observed in the wetlands. Stream SP is incised N4' below the wetlands.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WG/WH-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer rubrum 30% Y FAC That Are OBL, FACW,or FAC: 4 (A)
2.Liquidambar styraciflua 25% Y FAC
Total Number of Dominant
3• Species Across All Strata: 5 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 80% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
55% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.None FAC species x 3=
2. FACU species x 4=
3. UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
=Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Digitaria sanguinalis 45% Y FACU _ Problematic Hydrophytic Vegetation' (Explain)
2. Carex sp. 20% Y FAC
3.Juncus effusus 20% Y FACW 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
85% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.None height.
2.
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
=Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WG/WH-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-5" 10YR 3/1 100% Sandy loam
5-15" 10YR 4/1 95% 7.5YR 3/4 5% C M Sandy loam
15-25" 10YR 5/1 70% 10YR 6/8 30% C M Sandy clay
25-30" 10YR 4/1 98% 10YR 6/6 2% C M Clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) ❑ Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
✓ Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
The water table and soil saturation was observed at the soil surface.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/2/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WI/WJ-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Levee Local relief concave,convex,none): Convex Sloe % 1%
Landform(hillslope,terrace,etc.): ( ) p ( ):
Subregion(LRR or MLRA): LRR P Lat: 36.127164 Long: -80.112865 Datum: NAD 83
Soil Map Unit Name: Hatboro loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No IZI
Wetland Hydrology Present? Yes_ _ No ✓
Remarks:
WIM-UP is on a natural levee between Kerners Mill Creek and the wetlands. The creek appears to flood
regularly. The upland data point is —33' northwest of and V higher in elevation than the wetland data
point location.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >30"
Saturation Present? Yes= Non Depth(inches): >30" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WIM-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer rubrum 40% Y FAC That Are OBL, FACW,or FAC: 5 (A)
2.Liquidambar styraciflua 15% Y FAC
Total Number of Dominant
3• Species Across All Strata: 8 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 62.5% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
55% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Rosa multiflora 10% Y FACU FAC species x 3=
2.Ligustrum sinense 10% Y FACU FACU species x 4=
3.Nandina domestics 5% N NI UPL species x 5=
4.Fagus grandifolia 5% N FACU Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
30% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 30% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.Allium canadense 10% Y FACU
3. Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
40% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Lonicera.japonica 10% Y FAC height.
2.Vitis rotundifolia 10% Y FAC
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
20% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The upland data point was taken on a creek levee.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WI/WJ-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-2" 10YR 3/3 100% Loam
2-15" 7.5YR 4/4 100% Loam
15-24" 10YR 5/3 80% 7.5YR 5/4 20% C M Loamy clay
24-30" 7.5YR 5/1 60% 7.5YR 4/5 40% C M Loamy clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) ❑ Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
The water table and soil saturation was not observed within the upper 30" of the soil profile. No
indicators of hydric soils were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/2/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WI/WJ-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Bottomland floodplain Local relief(concave,convex,none): None Slope(%): <1%
Subregion(LRR or MLRA): LRR P Lat: 36.127085 Long: -80.112805 Datum: NAD 83
Soil Map Unit Name: Hatboro loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� Non (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetlands WI and WJ are in a floodplain associated with Kerners Mill Creek. WI and WJ are both bounded
by topography to include roads and the creek levee. WI and WJ are separated by a sewer/stormwater
utility easement.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
✓ Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑✓ Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
✓ Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes ✓ No Depth(inches): 0-2
Water Table Present? Yes n✓ _ No-4 Depth(inches): Surface
Saturation Present? Yes i v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No n
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
Wetlands WI and WJ are likely inundated throughout much of the dormant season and appears to
receive frequent flooding. Groundwater is present at the surface throughout much of the wetland
and small hummocks/rises are present within the floodplain.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WI/WJ-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer rubrum 60% Y FAC That Are OBL, FACW,or FAC: 8 (A)
2.Liquidambar styraciflua 35% Y FAC
Total Number of Dominant
3• Species Across All Strata: 9 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 88'9% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
95% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Acer rubrum 20% Y FAC FAC species x 3=
2.Liquidambar styraciflua 10% Y FAC FACU species x 4=
3. UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
30% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 25% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.Rubus argutus 15% Y FACU
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
40% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Vitis rotundifolia 15% Y FAC height.
2.Smilax rotundifolia 5% Y FAC
3.Lonicera_japonica 5% Y FAC
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
25% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The wetland data point is within a bottomland floodplain forest.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WI/WJ-WE-F
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-3" 10YR 3/5 100% Sandy loam
3-12" 10YR 5/2 70% 7.5YR 4/5 30% C M Sandy clay loam
12-24" 7.5YR 5/2 90% 7.5YR 5/6 90% C M Clay
24-30" 7.5YR 5/2 100% Sand
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
The soil profile was saturated throughout. The wetlands are within a floodplain and soils are
indicative of frequent saturation/inundation with alluvial deposition. Below 24" the soil profile
becomes sandy and could not be removed.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/2/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WL/WM/WN-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Hillslope Local relief(concave,convex,none): None Slope(%): 6-101/o
Subregion(LRR or MLRA): LRR P Lat: 36.133626 Long: -80.115312 Datum: NAD 83
Soil Map Unit Name: Gullied land NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes _ No ✓
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No IZI
Wetland Hydrology Present? Yes_ No ✓
Remarks:
WL/WM/WN-UP is N 20' north of and 5' higher in elevation than the wetland data point on the
adjacent hillslope.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >24"
Saturation Present? Yes= Non Depth(inches): >24" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WL/WM/WN-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Liriodendron tulipifera 40% Y FACU That Are OBL, FACW,or FAC: 4 (A)
2.Fagus grandifolia 20% Y FACU
Total Number of Dominant
3.Acer rubrum 10% Y FAC Species Across All Strata: 8 (B)
4.Oxydendrum arboreum 10% Y UPL
Percent of Dominant Species
5 That Are OBL, FACW,or FAC: 50% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
40% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1•Carya Qlabra 15% Y FACU FAC species 30% x 3= 90%
2.Acer rubrum 5% Y FAC FACU species 75% x 4= 300
3. UPL species 10% x 5= 50
4. Column Totals: 115 (A) 440 (B)
5.
Prevalence Index =B/A= 3.83
6.
7 Hydrophytic Vegetation Indicators:
1 -Rapid Test for Hydrophytic Vegetation
8.
2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
20% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.None Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
=Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Smilax rotundifolia 10% Y FAC height.
2.1oxicodendron radicans 5% Y FAC
3.
4.
5 Hydrophytic
VegetationF1
6• Present? Yes No
15% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Dense canopy cover with a sparse understory.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WL/WM/WN-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-5" 10YR 3/2 100% Loam
5-10" 10YR 4/2 100% Loam
10-24" 10YR 7/2 100% Sand
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
Below 24", the soil was too sandy for auger removal/analysis. No water table or soil saturation was
observed within 24".
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/2/2016
Applicant/Owner: NCDOT State: NC Sampling Point:WL/WM/WN-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Hillside seep Local relief(concave,convex,none): Concave Slope(%): <1%
Subregion(LRR or MLRA): LRR P Lat: 36.133565 Long: -80.115305 Datum: NAD 83
Soil Map Unit Name: Gullied land NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetlands WL, WM, and WN are seep wetlands in small topographic features that are adjacent to
and drain to stream SS. The wetlands are narrow and likely saturate year round by groundwater.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) ✓ Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
✓ Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
✓ Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes ✓ No Depth(inches): 0-2
Water Table Present? Yes 2✓ _ No-4 Depth(inches): Surface
Saturation Present? Yes i v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No signs of flooding or hydrologic input from stream SS. It appears that the seeps are
predominantly maintained by groundwater seeping from adjacent hillsides. The water table and soil
saturation were both observed at the surface.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WL/WM/WN-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.None That Are OBL, FACW,or FAC: 4 (A)
2. Total Number of Dominant
3• Species Across All Strata: 6 (B)
4.
Percent of Dominant Species 66.7%
5. That Are OBL, FACW,or FAC: (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
=Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Ligustrum sinense 5% Y FACU FAC species x 3=
2.Ilex opaca 5% Y FACU FACU species x 4=
3.Acer rubrum 5% Y FAC UPL species x 5=
4,Carpinus caroliniana 5% Y FAC Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
20% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.None Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12. of size,and woody plants less than 3.28 ft tall.
=Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Smilax rotundifolia 5% Y FAC height.
2.1oxicodendron radicans 5% Y FAC
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
5% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The canopy trees are located in upland areas. The sapling/shrubs present are small.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WL/WM/WN-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-5" 10YR 4/1 100% Sandy loam roots present
5-10" 10YR 4/1 60% 10YR 6/1 40% D M Sandy loam
10-14" 10YR 6/2 100% Sand
14-24" 10YR 6/1 100% Sandy clay
24-30" 10YR 5/1 100% Sandy clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF 1 Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
The water table and saturated soils were observed at the surface.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/2/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WO-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Hillslope Local relief(concave,convex,none): None Slope(%): 3%
Subregion(LRR or MLRA): LRR P Lat: 36.128439 Long: -80.115145 Datum: NAD 83
Soil Map Unit Name: Fairview fine sandy loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No IZI
Wetland Hydrology Present? Yes I I No ✓
Remarks:
WO-UP is —25' west of and 1.5' higher in elevation than the wetland data point. The upland data
point was taken toe of a roadside fillslope.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >26"
Saturation Present? Yes= Non Depth(inches): >26" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)—Use scientific names of plants. Sampling Point: WO-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer rubrum 20% Y FAC That Are OBL, FACW,or FAC: 6 (A)
2.Liriodendron tulipifera 20% Y FACU
Total Number of Dominant
3• Species Across All Strata: 11 (B)
4.
Percent of Dominant Species o
5. That Are OBL, FACW,or FAC: 54.5/o (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
40% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1•Acer rubrum 5% Y FAC FAC species x 3=
2.Rosa multiflora 5% Y FACU FACU species x 4=
3.Liquidambar styraciflua 5% Y FAC UPL species x 5=
4•Ligustrum sinense 5% Y FACU Column Totals: (A) (B)
5.Ilex opaca 5% Y FACU
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
25% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Allium canadense 5% Y FACU Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree—Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub—Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb—All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
=Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine—All woody vines greater than 3.28 ft in
1.Toxicodendron radicans 5% Y FAC height.
2.Lonicera japonica 5% Y FAC
3.Smilax rotundifolia 5% Y FAC
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
15% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

SOIL Sampling Point:WO-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-2" 10YR 3/3 100% Loam
2-10" 7.5YR 4/6 100% Sandy loam
10-18" 7.5YR 5/6 100% Loam
18-24" 7.5YR 4/6 100% Sandy loam
24-26" 10YR 4/4 100% Sandy clay loam
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF 1 Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
No hydric soil indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/2/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WO-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Floodplain Local relief(concave,convex,none): Concave Slope(%): 1-2%
Subregion(LRR or MLRA): LRR P Lat: 36.126585 Long: -80.113299 Datum: NAD 83
Soil Map Unit Name: Fairview fine sandy loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� Non (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetland WO is a floodplain wetland adjacent to perennial stream SS. WO is mostly within a
maintained power-line utility easement.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑✓ Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
✓ Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes I v l No Depth(inches): 1
Water Table Present? Yes n✓ _ No-4 Depth(inches): Surface
Saturation Present? Yes i v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No n
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
The water table and soil saturation was observed at the surface within depressional pockets in the
wetland. Surface water to a depth of N1" was also observed in the depressions. Hydrology appears
to be from a combination of groundwater and flooding from stream SS.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WO-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer rubrum 20% Y FAC That Are OBL, FACW,or FAC: 4 (A)
2. Total Number of Dominant
3• Species Across All Strata: 7 (B)
4.
Percent of Dominant Species o
5. That Are OBL, FACW,or FAC: 57.1 /o (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
20% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Ligustrum sinense 5% Y FACU FAC species x 3=
2.Liquidambar styraciflua 5% Y FAC FACU species x 4=
3.Rosa multiflora 5% Y FACU UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
15% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 30% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.Rubus argutus 25% Y FACU
3.Juncus effusus 10% N FACW 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12. of size,and woody plants less than 3.28 ft tall.
65% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Lonicera.japonica 35% Y FAC height.
2.
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
35% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WO-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-6" 10YR 4/1 85% 7.5YR 4/6 15% C PL Loam
6-14" 7.5YR 5/6 100% Sandy loam
14-24" 10YR 5/8 80% 10YR 6/3 20% D M Sandy loam
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) ❑ Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
Much of the wetland is within a power-line utility easement.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/2/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WP-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Bottomland Local relief(concave,convex,none): Concave Slope(%): 1-2%
Subregion(LRR or MLRA): LRR P Lat: 36.126546 Long: -80.113370 Datum: NAD 83
Soil Map Unit Name: Hatboro loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No v
Wetland Hydrology Present? Yes I I No ✓
Remarks:
WP-UP is —20' west of and 1' higher in elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >30"
Saturation Present? Yes= Non Depth(inches): >30" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point. While WP-UP is located
within a floodplain, Kerners Mill Creek as been historically incised and artificial levees were created
west of Hopkins Road that prevent frequent flooding in much of the floodplain.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WP-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Platanus occidentalis 40% Y FACW That Are OBL, FACW,or FAC: 4 (A)
2.Acer rubrum 30% Y FAC
Total Number of Dominant
3.Prunus serotina 25% Y FACU Species Across All Strata: 7 (B)
4.
Percent of Dominant Species o
5. That Are OBL, FACW,or FAC: 57.1 /o (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
95% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Ligustrum sinense 15% Y FACU FAC species x 3=
2.Rosa multiflora 10% Y FACU FACU species x 4=
3.Liquidambar styraciflua 5% N FAC UPL species x 5=
4.Acer rubrum 5% N FAC Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
35% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.None Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
=Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Lonicera.japonica 10% Y FAC height.
2.Vitis rotundifolia 10% Y FAC
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
20% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WP-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-12" 10YR 4/4 95% 7.5YR 4/6 5% C M Sandy clay loam Faint concentrations
12-20" 10YR 3/2 95% 7.5YR 4/6 5% C M Sandy clay loam
20-24" 10YR 4/3 100% Sand
24-30" 2.5Y 6/2 95% 5YR 3/4 5% C M Sandy loam
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
No indicators of hydric soil were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/2/2016
Applicant/Owner: NCDOT State: NC Sampling Point: WP-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Floodplain pool Local relief(concave,convex,none): Concave Slope(%): <1%
Subregion(LRR or MLRA): LRR P Lat: 36.126585 Long: -80.113299 Datum: NAD 83
Soil Map Unit Name: Hatboro loam NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetland WP is a flooplain depressional feature located between stream SV, Kerners Mill Creek, and
Hopkins Road. Approximately half of WP is within an overhead power-line utility easement. WP may be
isolated except during flooding events from Kerners Mill Creek.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
✓ Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
✓ Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes ✓ No Depth(inches): 1-2
Water Table Present? Yes 2✓ _ No-4 Depth(inches): Surface
Saturation Present? Yes i v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
Wetland WP is within a floodplain of Kerners Mill Creek. Both Kerners Mill Creek and stream SV are
deeply incised on the west side of Hopkins Road. WP likely receives hydrology from infrequent
flooding of nearby streams and from stormwater from upslope neighborhoods and Hopkins Road.
Water is also perched at WP due to a restrictive clay layer at N8" deep.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WP-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Platanus occidentalis 40% Y FACW That Are OBL, FACW,or FAC: 5 (A)
2.Acer rubrum 10% N FAC
Total Number of Dominant
3.Fraxinus pennsylvanica 10% N FACW Species Across All Strata: 6 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 83'3% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
60% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Acer rubrum 30% Y FAC FAC species x 3=
2. FACU species x 4=
3. UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
30% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Rubus argutus 90% Y FACU _ Problematic Hydrophytic Vegetation' (Explain)
2.
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
90% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Vitis rotundifolia 5% Y FAC height.
2.Toxicodendron radicans 5% Y FAC
3.Lonicera_japonica 5% Y FAC
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
15% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The sapling shrub layers are present within the easement and are dominated by blackberry.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WP-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-8" 10YR 4/1 70% 7.5YR 4/6 30% C M Clay loam
8-24" 10YR 3/1 90% 7.5YR 4/3 10% C M Clay OM throughout
24-30" 7.5YR 5/1 100% Sandy clay
30-36" 7.5YR 5/1 75% 7.5YR 4/4 25% C M Clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
The water table and soil saturation were observed a the surface. A hard restrictive clay layer is
perching the water. 1-2" of standing water was observed within the wetland.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/8/2016
Applicant/Owner: NCDOT State: NC Sampling Point:WQ/WR/WS-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Slight hillslope Local relief(concave,convex,none): Concave Slope(%):
Subregion(LRR or MLRA): LRR P Lat: 36.126845 Long: -80.115648 Datum: NAD 83
Soil Map Unit Name: Water (No longer accurate as pond is drained) NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� No❑ (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No❑
Are Vegetation❑Soil R or Hydrology❑naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
✓ Is the Sampled Area
Hydric Soil Present? Yes _ No within a Wetland? Yes No IZI
Wetland Hydrology Present? Yes I I No ✓
Remarks:
WQ/WR/WS-UP is on the upland edge of the former pond bed associated with a series of
connected, constructed fish hatchery ponds.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
Saturation (A3) Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations: ����
Surface Water Present? Yes EL No Depth(inches):
Water Table Present? Yes 0_ No ✓ Depth(inches): >30"
Saturation Present? Yes= Non Depth(inches): >30" Wetland Hydrology Present? Yes n No ❑
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point. Pond at WS was drained
N5-6 years ago, whereas the ponds associated with WQ/WR were drained —20 years ago.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WQ/WR/WS-UP
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Acer rubrum 40% Y FAC That Are OBL, FACW,or FAC: 8 (A)
2.Liquidambar styraciflua 40% Y FAC Total Number of Dominant
3.Liriodendron tulipifera 10% N FACU Species Across All Strata: 9 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 88'9% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
90% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Acer rubrum 20% Y FAC FAC species x 3=
2.Liquidambar styraciflua 20% Y FAC FACU species x 4=
3.Ligustrum sinense 15% Y FACU UPL species x 5=
4.Rosa multiflora 5% N FACU Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
60% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 50% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.Rubus argutus 10% N FACU
3. 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12• of size,and woody plants less than 3.28 ft tall.
60% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.Lonicera.japonica 5% Y FAC height.
2.Toxicodendron radicans 5% Y FAC
3.Smilax rotundifolia 5% Y FAC
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No
15% =Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Herbaceous vegetation and sparse sapling/shrub cover present in the relict pond bed, while the canopy trees and vines
are present on the berm.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WQ/WR/WS-UP
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-3" 10YR 3/3 100% Sand
3-10" 10YR 4/4 100% Sand
10-15" 2.5Y 5/4 85% 7.5YR 5/6 15% C M Clay
15-30" 10YR 4/1 80% 10YR 5/6 20% C M Sandy clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF 1 Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
No hydric soil indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 City/County: Kernersville/Forsyth Sampling Date: 2/8/2016
Applicant/Owner: NCDOT State: NC Sampling PointWQ/WR/WS-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) Section,Township,Range: Kernersville
Landform(hillslope,terrace,etc.): Relict pond Local relief(concave,convex,none): Concave Slope(%): <1%
Subregion(LRR or MLRA): LRR P Lat: 36.126916 Long: -80.115673 Datum: NAD 83
Soil Map Unit Name: Water (No longer accurate as pond is drained) NWI classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? Yes ✓� Non (If no,explain in Remarks.)
Are Vegetation F—]Soil or Hydrology F—I significantly disturbed? Are"Normal Circumstances"present? Yes= No
Are Vegetation n Soil R or Hydrology n naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS—Attach site map showing sampling point locations,transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ _ No
Is the Sampled Area
Hydric Soil Present? Yes ✓ _ No within a Wetland? Yes No
Wetland Hydrology Present? Yes— ✓ _ No
Remarks:
Wetlands WQ, WR, and WS are all concave depressional wetlands within a series of relict pond
beds that were drained 5-20 years ago. The wetlands are bounded by topography on all sides.
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two required)
Primary Indicators(minimum of one is required:check all that apply) Surface Soil Cracks(136)
✓ Surface Water(Al) True Aquatic Plants(1314) Sparsely Vegetated Concave Surface(138)
✓ High Water Table(A2) Hydrogen Sulfide Odor(Cl) Drainage Patterns(610)
✓ Saturation (A3) ✓ Oxidized Rhizospheres on Living Roots(C3) Moss Trim Lines(1316)
Water Marks(131) Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
Drift Deposits(B3) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(64) ❑Other(Explain in Remarks) Stunted or Stressed Plants(D1)
Iron Deposits(135) ❑✓ Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard (D3)
Water-Stained Leaves(139) Microtopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes 0_ No y I I_ Depth(inches):
Water Table Present? Yes n✓ _ No IL�IL Depth(inches): Surface
Saturation Present? Yes I v l Non Depth(inches): Surface Wetland Hydrology Present? Yes M No n
includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections), if available:
Remarks:
Wetlands WQ, WR, and WS are sustained by groundwater and precipitation. WQ has standing water
throughout, while WR and WS have pockets of surface water. There are numerous artificially placed
boulders and large rocks in and around WQ.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

VEGETATION (Four Strata)-Use scientific names of plants. Sampling Point: WQ/WR/WS-WET
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum (Plot size: 30' ) %Cover Species? Status Number of Dominant Species
1.Salix nigra 100/0 Y OBL That Are OBL, FACW,or FAC: 5 (A)
2. Total Number of Dominant
3• Species Across All Strata: 5 (B)
4.
Percent of Dominant Species
5. That Are OBL, FACW,or FAC: 100% (A/B)
6.
7 Prevalence Index worksheet:
8 Total% Cover of: Multiply by:
10% =Total Cover OBL species x 1 =
Sapling/Shrub Stratum (Plot size: 30' ) FACW species x 2=
1.Salix nigra 5% Y OBL FAC species x 3=
2.Platanus occidentails 5% Y FACW FACU species x 4=
3. UPL species x 5=
4. Column Totals: (A) (B)
5.
Prevalence Index =B/A=
6.
7 Hydrophytic Vegetation Indicators:
_ 1 -Rapid Test for Hydrophytic Vegetation
8 X 2-Dominance Test is>50%
9.
3-Prevalence Index is:53.0'
10.
4-Morphological Adaptations' (Provide supporting
10% =Total Cover
Herb Stratum (Plot size: 15' ) data in Remarks or on a separate sheet)
1.Microstegium vimineum 40% Y FAC _ Problematic Hydrophytic Vegetation' (Explain)
2.Juncus effusus 40% Y FACW
3.Scirpus cyperinus 15% N FACW 'Indicators of hydric soil and wetland hydrology must
4. be present, unless disturbed or problematic.
5. Definitions of Four Vegetation Strata:
6. Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
7 more in diameter at breast height(DBH),regardless of
height.
8.
9 Sapling/Shrub-Woody plants,excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
10. m)tall.
11.
Herb-All herbaceous(non-woody)plants,regardless
12. of size,and woody plants less than 3.28 ft tall.
95% =Total Cover
Woody Vine Stratum (Plot size: 30' ) Woody vine-All woody vines greater than 3.28 ft in
1.None height.
2.
3.
4.
5 Hydrophytic
Vegetation
6• Present? YesP1 No El
=Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The eastern relict ponds were drained over 20 years ago, whereas the western pond was drained N5-6 years ago due
to a breech in the pond berm.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point:WQ/WR/WS-WET
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color(moist) % Color(moist) % Type' LocZ Texture Remarks
0-5" 10YR 5/2 90% 7.5YR 4/6 10% C PL Clay
5-9" 7.5YR 5/3 100% Sand
9-15" 10YR 5/2 85% 10YR 5/6 15% C M Sandy clay
15-20" 10YR 5/1 90% 10YR 6/6 10% C M Sandy clay loam
20-25" 10YR 6/1 95% 10YR 5/6 5% C M Sandy clay
'Type: C=Concentration, D=Depletion,RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol(Al) ❑ Dark Surface(S7) ❑ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) IF 1 Polyvalue Below Surface(S8)(MLRA 147, 148) ❑ Coast Prairie Redox(A16)
Black Histic(A3) ❑ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Hydrogen Sulfide(A4) Loamy Gleyed Matrix(F2) ❑ Piedmont Floodplain Soils(F19)
Stratified Layers(A5) ✓ Depleted Matrix(F3) (MLRA 136,147)
❑ 2 cm Muck(A10)(LRR N) Redox Dark Surface(F6) ❑ Very Shallow Dark Surface(TF12)
Depleted Below Dark Surface(A11) Depleted Dark Surface(F7) ❑ Other(Explain in Remarks)
Thick Dark Surface(Al2) ❑ Redox Depressions(F8)
Sandy Mucky Mineral (S1)(LRR N, ❑ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
❑ Sandy Gleyed Matrix(S4) ❑ Umbric Surface(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
❑ Sandy Redox(S5) ❑ Piedmont Floodplain Soils(F19) (MLRA 148) wetland hydrology must be present,
❑ Stripped Matrix(S6) ❑ Red Parent Material(F21)(MLRA 127,147) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes_a No ❑
Remarks:
The water table and saturated soils were observed at the surface. The soils were to saturated and
sandy for removal/analysis.
US Army Corps of Engineers Eastern Mountains and Piedmont—Version 2.0

#
L_USACE All?# DW Q Site# (indicate on attached map)
M STREAM QUALITY ASSESSMENT WQRKSHEET
Provide the following information for the stream reach under assessment:
1.Applicant's name: 2.Evaluator's name:
3.Date of evaluation: 4.Time of evaluation:
5.Name of stream: fi.River basin: 4
7.Approximate drainage area: 8.Stream order:
9.Length of reach evaluated: 10.County:
11.Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any):
Latitude(ex.34-872312): Longitude(ex.—77-556611). -
Method location determined(circle): l GP Topo Sheet Ortho{Aerial}Photol i'S Other GIS Other
13.Location of reach under evaluation(note nearby roads and landmarks-and'"attach map identifying streams)location):
14.Proposed channel work(if any): v
15.Recent weather conditions:
16.Site conditions at time of visit:
17.Identify any special waterway classifications known: _Section 10 Tidal Waters _Essential Fisheries Habitat
Trout Waters _Outstanding Resource Waters _Nutrient Sensitive Waters VWater Supply Watershed (I-IV)
1S.is there a pond or lake located upstream of the evaluation point?. YES NO 1f yes,estimate the water surface area•.
19. Does channel appear on USGS quad map? YES NO 20.Does channel appear on USDA Soil Survey? "E NO
21.Estimated watershed land use: %Residential �%Commercial _%Industrial =%Agricultural
%Forested _%Cleared 1 Logged _%Other( }
22.Bankfull width: 23.Bank height(from bed to top of bank):
r
24.Channel slope clown center of stream: _Flat(0 to 2%) _Gentle(2 to 41/o) _Moderate(4 to 100/*) _Steep(>I0%)
25.Channel sinuosity: Straight Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location,terrain,vegetation,stream classification,etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. if a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scaring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review(e.g.,the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity,and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100,with a score of 100 representing a stream of the
highest quality.
n �
Total Score (from reverse): Comments:
Evaluator's Signature Date
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—versian 06/03. To Comment,please tail 919-876-8441 x 26.
I

STREAM QUALITY ASSESSMENT WORKSHEET
ECOREGION POINT RANGE
# CHARACTERISTICS SCORE
Coastal Piedmont mountain
I Presence of now I persistent pools in stream 0-5 0-4 0-5
no flow or saturation=0;strong flow=maxpoints)
Evidence of past human alteration
2 0 fi 0-5 0-5
extensive alteration=0;no alteration=maxpoints)
3 Riparian zone 0—6 0-4 0-5
n❑buffer=0;Conti uous,wide buffer=maxpoints)
4 Evidence of nutrient or chemical discharges 0-5 0-4 0-4
(extensive discharges=0;no discharges=maxpoints)
5 Groundwater discharge 0-3 0-4 0-4
V no discharge=0;s rin s seeps,wetlands,etc.=maxpoints)
6 Presence of adjacent floodplain 0-4 0-4 0-2
no floodplain=0;extensive floodplain=max points
7 Entrenchment 1 floodplain access 0-5 0-4 0-2
(deeply entrenched=0;frequent flooding=maxpoints)
8 Presence of adjacent wetlands 0_6 0-4 0-2
no wetlands=0;large adjacent wetlands=max pDints)
9 Channel sinuosity 0-5 0-4 0-3
extensive channelization=0;natural meander=max pDints
10 Sediment input 0-5 0-4 0-4
extensive de osition=0;little or no sediment=maxpoints)
i i Size&diversity of channel bed substrate NA* 0-4 0-5
fine,homogenous=0;large,diverse sizes=maxpoints)
Evidence of channel incision or widening 0-5 0-4 0-5
12 (deeply incised=0•stable bed&banks=maxpoints)
Presence of major bank failures 0-5 0-5 0-5
13 severe erosion=0;no erosion,stable banks=maxpoints)
Q 14 Root depth and density on banks
=
(no visible roots=0;dense roots throughout maxpoints) 1 0-3 0-4 0-5
U� 15 Impact by agriculture, livestock,or timber production 0-5 0-4 0-5
(substantial impact=0;no evidence=maxpoints)
16 Presence of riffle-pool/ripple-pool complexes 0-3 0-5 0-6
F no riffles/ripples or pools=0;well-developed=maxpoints)
Habitat complexity 0 6 0_6 0-6
Fy 1 little or no habitat=0;frequent,varied habitats=max points)
Q18 Canopy coverage over streambed 0_5 0-5 0-5
tZ no shadingvegetation=0;continuous canopy=max points)
19 Substrate embeddedness NA* 0-4 0-4
(deeply embedded=0;loose structure=max)
20 Presence of stream invertebrates(see page 4) 0-4 0-5 0-5
no evidence=0;common,numerous types=maxpoints)
21 Presence of amphibians 0_4 0-4 0-4
Q (no evidence=0;common,numerous es=max Dints}
© �2 Presence of fish 0-4 0-4 0-4
no evidence=0;common,numerous es-maxpoints)
23 Evidence of wildlife use 0-6 0-5 0-5
no evidence=0;abundant evidence W max oints
Total Points Possible 100 100 100
77-7
TOTAL SCORE (also enter on first page)
These characteristics are not assessed in coastal streams.
2

NC DWQ Stream Identification Form Version 4.11
Date: Project/Site: Latitude: '36 f r' qc)9
Evaluator: County: S Longitude: -�D, $�G�
Total Points: Stream Determination(circle one) Other
Stream is at least intermittent Ephemeral Intermittent Perennial e.g.Quad Name:
if z 19 or perennial it z 30*
A. Geomorphology (Subtotal= ) Absent Weak Moderate Strong
1 a'Continuity of channel bed and bank 0 1 2 3-
2-Sinuosity of channel along thalweg 0 1 2 3
3. In-channel structure:ex. riffle-pool,step-pool, 0 1 2 3
-ripple-pool sequence
4. Particle size of stream substrate 0 1 2 3
5.Active/relict floodplain 0 1 2 ' 3
6. Depositional bars or benches 0 1 2 3
7.Recent alluvial deposits 0 1 2 3
8. Headcuts 0 1 2 3
9.Grade control 0 0.5 1 1.5
10. Natural valley 0 0.5 1 1.5
11. Second or greater order channel Ne=0 Yes=3
artificial ditches are not rated;see discussions in manual
B. Hydrology Subtotal=
12. Presence of Baseflow 0 1 2 3
13. Iron oxidizing bacteria 0 1 2 3
14. Leaf litter 15 1 0.510
15. Sediment on plants or debris 0 0.5 1 1.5
16. Organic debris lines or piles 0 0.5 1 1.5
17.Soil-based evidence of high water table? No=❑ Yes=3
C. Biology Subtotal=
18. Fibrous roots in streambed 3 2 1 0
19. Rooted upland plants in streambed 3 2 1 0
20. Macrobenthos(note diversity and abundance) 0 1 2 3
21.Aquatic Mollusks 6 1 2 3
22. Fish 0:: 0.5 1 1.5
23. Crayfish 0.5 1 1.5
24.Amphibians 0 0.5 1 1.5
25.Algae 0 0.5 1 1.5
26.Wetland plants in streambed FACW=0.75; OBL=1.5 Other=0
'perennial streams may also be identified using other methods.See p.35 of manual.
Notes:
Sketch:

LUS�AE2AD# DWQ# Site# (indicate on attached map}
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1.Applicant's name: 2.Evaluator's name:
3.Date of evaluation: 4.Time of evaluation:
5.Name of stream: 6.River basin:
7.Approximate drainage area: :. 8.Stream order: _
9.Length of reach evaluated: 10.County:_, >°iCT 1J
11.Site coordinates(if known): prefer in decimal degrees. 12.Subdivision name(if any): --
Latitude(ex.34.872312): J , Longitude(ex--77.556611)' 1s ? FOL4
Method location determined(circle): LG Topo Sheet Ortho(Aerial)Photo/GlS Other G!S Other
13.Location of reach under evaluation(note nearby roads and landmarks and attach map identifying stream(s)location):
14.Proposed channel work(if any):
15.Resent weather conditions: -
16.Site conditions at time of visit:
17. Identify any special waterway classifications known: Sect ion 10 _Tidal Waters TEssential Fisheries Habitat
Trout Waters _Outstanding Resource Waters _Nutrient Sensitive Waters _Water Supply Watershed-IL(I-IV)
18.Is there a pond or lake located upstream of the evaluation point? YES NO If yes,estimate the water surface area:
19.Does channel appear on USGS quad map? YES NO 20.Does channel appear on USDA Soil Survey? YES NO
21.Estimated watershed land use: ,%Residential !%Commercial _%Industrial ,°/o Agricultural
�%Forested _%Cleared 1 Logged _%Other( }
22.Bankfull width: 23.Bank height(from bed to top of bank):
24.Channel slope down center of stream: ^Flat(0 to 2%) iL. Gentle(2 to 4%) _Moderate(4 to 10%) —Steep(>10%)
25.Channel sinuosity: Straight �Occasivnal bends Frequent meander _Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location,terrain,vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review(e.g.,the stream flows from a pasture
into a forest),the stream may be divided into smaller reaches that display more continuity,and a separate farm used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): Comments:
J
Evaluator's Signature - Date
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change—version 06103. To Comment,please call 919-876-WI x 26.
1

1
f
STREAM QUALITY ASSESSMENT WORKSHEET
# CHARACTERISTICS ECOREGION POINT RANGE SCORE
Coastal Piedmont Mountain
l Presence of flow 1 persistent pools in stream 0-5 0-4 0-5
no flow or saturation=0;strong flow=max points
Evidence of past human alteration
2 0-6 0-5 0-5
extensive alteration=0;no alteration=max points)
Riparian zone
0-6 0-4 0-5
no buffer=0;contiguous,wide buffer=maxpoints)
4 Evidence of nutrient or chemical discharges 0-5 0-4 0-4
extensive discharges=0;no discharges=maxpoints)
5 Groundwater discharge 0-3 0-4 0-4
(no discharge=0;springs,seeps,wetlands etc.=maxpoints)
" 6 Presence of adjacent floodplam 0—4 0—4 0—2
y� no flood lain=0•extensive flood lain=max points)
7 Entrenchment/floodplain access 0-5 0-4 0-2
(deeply entrenched=0;frequent flooding=maxpoints)
8 Presence of adjacent wetlands 0-6 0-4 0-2
no wetlands=0;large adjacent wetlands=max Dints
9 Channel sinuosity 0-5 0-4 0—3
extensive channelization=0;natural meander=maxpoints)
10 Sediment input 0-5 0-4 0-4
extensive de osition=0;little or no sediment=maxpoints)
11 Size&diversity of channel bed substrate NA* 0-4 0-5
fine,homogenous=0;large,diverse sizes=maxpoints)
12 Evidence of channel incision or widening 0-5 0-4 0-5
y, (deeply incised=0•stable bed&banks=maxpoints)
13 Presence of major bank failures
severe erosion=0;no erosion stable banks=max Dints) 0-5 0-5 0-5
14 Root depth and density on banks 0-3 0-4 0 5
no visible roots=0;dense roots throughout=ruax points)
15 impact by agriculture, livestock,or timber production 0._5 0-4 0-5
substantial impact=0;no evidence=max pints)
16 Presence of riffle-pool/ripple-pool complexes D---3 6 5 0-6
no rifflestri les or pools=0;well-developed=max points)
Habitat complexity 0-6 0-6 0-6
E 17 little or no habitat=0;frequent,varied habitats=max points)
M 18 Canopy coverage over streambed 0_5 0_5 0—5
no shadingvegetation=0•continuous cane =max pints)
19 Substrate embeddedness NA* 0-4 0-4
(deeplyembedded=0;loose structure=max)
20 Presence of stream,invertebrates(see page 4) 0-4 0-5 0-5
no evidence=0;common numerous types=maxpoints)
{ Presence of amphibians 0-4 0--4 0-4
4 21 no evidence=0;common numerous types=max Dints
Presence of fish
0-4 0-4 0-4
22 (no evidence=0;common,numerous types=max Dints}
23 Evidence of wildlife use 0-6 0-5 0-5
no evidence=0•abundant evidence=maxPoints)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page)
*These characteristics are not assessed in coastal streams.

WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont l
Project/Site: City/County: Sampling Date:
Applicarst/Owner: �V - State: Sampling Point.": Qe
Investigator(s): Section,Township,Range:
Landform(hillslope,terrace,etc.): Local relief(cvnca)Wconvex,none): Slope(%):
Subregion(LRR or MLRA): Lat: Long: Datum:
Soil Map Unit Name: - `f NWI classification:
Are climatic I hydrologic conditions on the site typical for this time of yeah Yes No (If no,explain in Remarks.)
Are Vegetation Soil ,or Hydrology significantly disturbed? Are"Normal Circumstances"present? Yes No
Are Vegetation Soil or Hydrology naturally problematic? {If needed,explain any answers in Remarks.]
SUMMARY OF FINDINGS— Attach site map showing sampling point locations,transects,important features,etc.
Hydrophytic Vegetation Present? Yes -'' N❑ Is the Sampled Area
Hydric Soil Present? Yes f No within a Wetland? Yes No
Wetland Hydrology Present? Yes\.' Na
Remarks:
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators minimum of two reQ uired
Primary indicators(minimum of one is reauired:check all that apply) Surface Soil Cracks(136)
Surface Water(Al) — True Aquatic Plants(814) _ Sparsely Vegetated Concave Surface(68)
Nigh Water Table(A2) Hydrogen Sulfide Odor(C1) -X Drainage Patterns(810)
< Saturation(A3) Z Oxidized Rhizospheres on Living Roots(C3) _ Moss Trim Lines(816)
Water Marks(131) _ Presence of Reduced iron(C4) _ Dry-Season Water Table(C2)
Sediment Deposits(B2) _ Recent Iron Reduction in Tilled Soils[C6] — Crayfish Burrows[C8]
_ Drift Deposits(B3) _ Thin Muck Surface(C7) _ Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(84) Other(Explain in Remarks) Stunted a Stressed Plants[D1}
Iron Deposits(B5) Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) _ Shallow Acuitard(D3)
Water-Stained Leaves(139) _ Microtopogra phi c Relief(D4)
Aquatic Fauna(1313) _ FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes No Depth(inches):
Water Table Present? Yes No Depth[inches]:
Saturation Present? Yes ',r No Depth{inches}: Wetland Hydrology Present? Yes No
includes capillary frin e
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections),if available:
Remarks:
US Army Corps of Engineers Ea stem Mountains and Piedmont-Interim Version

VEGETATION (Four Strata)—Use scientific names of plants. Sampling Point
Absolute Dominant Indicator Dominance Test worksheet:
Tree Stratum (Plot size: } %Cover Species? Status Number of Dominant Species
That Are OBL,FACW,or FAC: (A)
2- Total Number of Dominant
3 Species Across All Strata:
Percent of Dominant Species
5. That Are OBL,FACW,or FAC: (A!B)
6.
Prevalence Indexworksheet:
?- Total%Cover of: Multiply b
8-
=Total Cover OBL species x 1 =
Saplingl5hrub Stratum (Plot size: } FACW species x 2=
`f•- FAC species x 3=
2 h FACU species x 4=
3 r f• UPL species x 5=
4 Column Totals: (A) (B)
5• Prevalence Index =BIA=
6-
pHydr—lophytic Vegetation indicators:
?• 1 -Rapid Test for Hydrophytic Vegetation
B.
2-Dominance Test is�; %
9. 3 P-revaleriCe
10. 4-Morphological Adaptations'(Provide supporting
=Total Cover data in Remarks or on a separate sheet)
Herb Stratum (Plot size: l J _ ProblematiC Hydrophytic Vegetation'(Explain)
2- Indicators of hydric soil and wetland hydrology must
g - - be present,unless disturbed or problematic.
4. Definitions of Four Vegetation Strata:
5.
Tree—Woody plants,excluding vines,3 in.(7-6 cm)or
6- more in diameter at breast height(DBH),regardless of
height-
8. SaplinglShrub—Woody plants,excluding vines,less
g than 3 in.DBH and greater than 3-2 8 It(1 m)tall.
10• Herb—All herbaceous(non-woody)plants,regardless
11 of size,and woody plants less than 3.28 ft tall-
12- Woody vine—All woody vines greater than 3.28 It in
=Total Cover height.
Woody Vine Stratum (Plot size: ]
1.
2,
3.
4. Hydrophytic
5. Vegetation
Present? Yes No
6.
=Total Cover
Remarks: (InGude photo numbers here or on a separate sheet-]
US Army Corps of Engineers Eastern Mountains and Piedmont—Interim Version

SOIL Sampling Point:
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inches) Color moist % Color(moist) _ % T, Lac Texture Remarks
'Type! C=Concentration,D=De letion,RM=Reduced Matrix,MS=Masked Sand Grains- 2Location: PL=Pore Lining,M=Matrix.
Hydric Soil indicators: Indicators for Problematic Hydric Soils':
_ Histosol(Al) Dark Surface(S7) _ 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) _ Polyvalue Below Surface(58)(MLRA 147,148) _ Coast Prairie Redox(A16)
Black Histic(A3) Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
_ Hydrogen Sulfide(A4) _ Loamy Gleyed Matrix(F2) ^ Piedmont Floodplain Soils(F19)
_ Stratified Layers(A5) _ Depleted-Matrix I�_ (MLRA 136,147)
2 cm Muck(A10)(LRR N) )Redox Dark Surface-(W — Red Parent Material(TF2)
_ Depleted Below Dark Surface(All) _ Depleted-Dirk Surface(F7) ! Very Shallow Dark Surface{TF12)
Thick Dark Surface(At 2) Redox Depressions(F8) — Other(Explain in Remarks)
Sandy Mucky Mineral(S1)(LRR N, _ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
_ Sandy Gleyed Matrix(S4) _ Umbric Surface(F13)(MLRA 136,122) 3lndicators of hydrophytic vegetation and
Sandy Redox(S5) _ Piedmont Floodplain Soils(F19)(MLRA 148) wetland hydrology must be present,
Stripped Matrix(55) unless disturbed or problernW.
Restrictive Layer(if observed):
Type: �
Hydric Soil Present? Yes = No
Depth(inches):
Remarks:
Eastern Mountains and Piedmont—Interim Version
US Army Corps of Engineers

Lr- ,W21 1
W-9---r
WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont
Project/Site:ect/Site: City/County: Sampling Date: 2 ��
1
Applicanyowner. State: Sampling Point: A�
Investigator(s): Section,Township,Range:
Landform(hiilslope,terrace,etc.): Local relief(concave,convex,none): Slope(%): __3
Subregion(LRR or MLRA): Lat: Long: Datum: ,,MD9
Soil Map Unit Name: NWI classification.
Are climatic 1 hydrologic conditions on the site typical for this time of year? Yes No (If no,explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are"Normal Circumstances"present? Yes No
Are Vegetation Soil or Hydrology naturally problematic? (it needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS— Attach site map showing sampling point locations,transects,important features,etc.
r
drophytic Vegetation Present? Yes No Is the Sampled Area
dric Soil Present? Yes No within a Wetland? Yes / Na
tiand Hydrology Present? Yes Nomarks:
HYDROLOGY
Wetland Hydrology Indicators: Se condo Ey Indicators minimum of two rec.uired
Primary Indicators minimum of one m re uired check all that a ly Surface Soil Cracks(96)
_ Surface Water(Al) _ True Aquatic Plants(B14) _ Sparsely Vegetated Concave Surface(68)
High Water Table(A2) Hydrogen Sulfide Odor(C1) _ Drainage Patterns(910)
Saturation(A3) - Oxidized Rhizospheres on Living Roots(C3} _ Moss Trim Lines(B16)
Water Marks(61) _ Presence of Reduced Iron(C4) , Dry-Season Water Table(C2)
Sediment Deposits(132) Recent Iron Reduction in Tilled Soils(C6) , Crayfish Burrows(C8)
Drift Deposits(63) _ Thin Muck Surface(C7) .— Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(134) _ Other(Explain in Remarks) — -Stunted or Stressed Plants(D1)
_ Iron Deposits(135) _ Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(B7) Shallow Aquitard(D3)
Water-Stained Leaves(139) _ Micratopographic Relief(D4)
Aquatic Fauna(B13) FAC-Neutral Test(D5)
Field Observations:
Surface Water Present? Yes No Depth(inches):
Water Table Present? Yes No Depth(inches):
Saturation Present? Yes No Depth(inches):
Wetland Hydrology Present? Yes_� No
includes ca illa Erin e
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections),if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont—Interim Version

-r,21
VEGETATION [Four Strata]—Use scientific names of plants. Sampling Point;
Absolute Dominant Indicator Dominance Test worksheet:
Tree Stratum (Plot size: ] %Cover Species? Status Number of Dominant Species
1 That Are OBL,FACW,or FAC: (A)
2. � r
Total Number of Dominant G
3. Species Across All Strata: (B)
4. Percent of Dominant Species
5. That Are OBL,FACW,or FAC: (NB)
6-
Prevalence Index worksheet:
7.
Total°Io Cover of; Multiply b
8. _
=Total Cover 08L species x 1=
Sa lin /Shrub Stratum (Plot size: } J FACW species x 2=
1. r, ff; FAC species x 3=
2 FACU species x 4=
3 UPL species x 5=
4 Column Totals: (A) (B)
5- Prevalence index =WA=
6.
F
hytic Vegetation indicators:
7 Raid Test for Hydrophytic Vegetation
8- Dominance Test is>54°k.
9 Prevalence lr�dex-is i 3iol
10. 4-Morphological Adaptations'(Provide supporting
=Total Cover data in Remarks or on a separate sheet)
Herb Stratum (Plot size: l f _ Problematic Hydrophytic Vegetation'(Explain)
2 J �,.r l,.
Indicators of hydric soil and wetland hydrology must
31 be present,unless disturbed or problematic.
4_ Definitions of Four Vegetation Strata:
5.
Tree—Woody plants,excluding vines,3 in.(7.6 cm)or
6. more in diameter at breast height(DSH),regardless of
7 height.
8. SaplinglShrub—Woody plants,excluding vines,less
9 than 3 in.DBH and greater than 3.28 ft(1 m)tall.
1 0• Herb—All herbaceous(non-woody)plants,regardless
11 of size,and woody plants less than 3.28 ft tall.
12• Woody vine—All woody vines greater than 3.28 ft in
Total Cover height.
Woody Vine Stratum (Plot size: 7 I T
J l;,ryt.
1.
2.
3.
4. Hydrophytic
5 Vegetation
Present? Yes No
6.
=Total Cover
Remarks: (include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont—Interim Version

SOIL Sampling Point.
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
inches Color moist % Color imoist) % Type Loc Texture Remarks
r
Fcentration,D-De letion,RM=Reduced Matrix,MS=Masked Sand Grains. 2Locatiom PL=Pore Linin ,M=Matrix.dicators: indicators for Problematic Hydric Soils':Dark Surface[S7} 2 cm Muck(At0)(MLRA 147)
A1} _ —
pedon(A2) Polyvalue Below Surface(S8)(MLRA 147,148) _ Coast Prairie Redox(At6)
tic(A3) f Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
Sulfide(A4] _ Loamy Gleyed Matrix(F2) — Piedmont Floodplain Soils(F19)
_ Stratified Layers(A5) — Depleted Matrix[F3] (MLRA 136,147)
2 cm Muck(A10)(LRR N) — Redox Dark Surface(F6) _ Red Parent Material(TF2)
—_ Depleted Below Dark Surface(A11) -"Depleted Dark Surface(F7) — Very Shallow Dark Surface(TF12)
Thick Dark Surface(Al2) — Redox Depressions(F8) Other(Explain in Remarks)
— Sandy Mucky Mineral(S1)(LRR N, — Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
'
Sandy Gleyed Matrix[S4] _ Umbric Surface(F13)(MLRA 136,122] Indicators of hydrophytic vegetation and
Sandy Redox(S5) Piedmont Floodplain Soils(F19)(MLRA 148) wetland hydrology must be present,
Stripped Matrix(SE) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): L Soil Present? Yes No
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont-Interim Version

65r7--W 244.74
WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont
Project/Site: City/County: Sampling Date: (/y I
Applicant/Owner: State: Sampling Point:
Investigator(s): Section,Township,Range:
Landform(hillslope,terrace,etc.): Local relief(concave,convex,none): Slope(%)-.
_�'Subregion(LRR or MLRA)7 Lat: Long: Datum:
Soil Map Unit Name: NWI classification:
Are climatic!hydrologic conditions on the site typical for this time of year? Yes No (If no,explain in Remarks.]
Are Vegetation Soil or Hydrology significantly disturped? Are"Normal Circumstances"present? Yes No
Are Vegetation Soil ,or Hydrology naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS— Attach site map showing sampling point locations,transects,important features,etc.
rHyd:ricSoil
ic Vegetation Present? Yes No is the Sampled Area f
Present? Yes No within a Wetland? Yes No_ 1ydrology Present? Yes No
marks:
HYDROLOGY
1Aqu
Hydrology Indicators: Secondary Indicators{minimum of two reauiredl
ndicators minimum of one is re uired check all that a I — Surface Soil Cracks(136)
ace Water(Al) — True Aquatic Plants(B14) , Sparsely Vegetated Concave Surface(B8)
Water Table(A2) , Hydrogen Sulfide Odor(C1) , Drainage Patterns(S10)
ration(A3) _ Oxidized Rhizospheres on Living Roots(C3) _ Moss Trim Lines(B16)
er Marks(B1) ! Presence of Reduced Iron(C4) , Dry-Season Water Table(C2)
iment Deposits(B2) _ Recent iron Reduction in Tilled Soils(CB) _ Crayfish Burrows(C8)
Deposits(63) _ Thin Muck Surface(C7) , Saturation Visible on Aerial Imagery(C9)
l Mat or Crust(134) — Other(Explain in Remarks) _, Stunted or Stressed Plants(Di)
Deposits(B5) — Geomorphic Position(D2)
dation Visible on Aerial Imagery(137) _ Shallow Aquitard(D3)
ter-Stained Leaves(B9) — Microtopographic Relief(D4)
FAC-Neutral Test(D5)
atic Fauna(B13)
Field Observations:
Surface Water Present? Yes No Depth(inches):
Water Table Present? Yes No Depth(inches):
Saturation Present? Yes No Depth(inches): Wetland Hydrology Present? Yes No
(includes ca itla Erin e
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections),if available:
Remarks:
Eastern Mountains and Piedmont—Interim Version
US Army Corps of Engineers

VEGETATION(Four Strata)—Use scientific names of plants. Sampling Point
Absolute Dominant indicator Dominance Test worksheets
Tree Stratum [Plot size: ] °Io Cover 5 Status Number of Dominant Species
rr'•' That Are 0BL,FACW,or FAC: (A)
2• J Total Number of Dominant
(B)
3. Species Across All Strata:
4• Percent of Dominant Species r �'
g• That Are OBL,FACW,or FAC: (NB)
6-
Prevafence index worksheets
7• Total°�Cover of: Multiply bv:
8 OBL species x 1 =
_ =Total Cover
Sa lin (Shrub Stratum (Plot size: } FACW species x 2=
FAC species x 3=
2 J f.ti r FACU species x 4=
3. UPL species x 5=
Column Totals: (A) [B]
4.
5- Prevalence Index =BIA=
6- Hydrophytic Vegetation Indicators:
7• _ 1-Rapid Test to-r hyd94)byl Vegetation
8- '2-Dominance Test is>50°I�
g• 3-Prevalence Index is�3-l}'
10. _ 4-Morphological Adaptations'(Provide supporting
=Total Cover data in Remarks or on a separate sheet)
Herb Stratum [Plot size: ] • Problematic Hydrophytic Vegetation'(Explain)
1.
2 Indicators of hydric soil and wetland hydrology must
3 ' be present,unless disturbed or problematic.
4 Fheight.
ons of Four Vegetation strata:
5 Woody plants,excluding vines,3 in.[7.6 cm]or
g diameter at breast height(DISH),regardless of
8• SaplinglShrub—Woody plants,excluding vines,less
9,
than 3 in.DBH and greater than 3,28 it(1 m)tall.
10, Herb—All herbaceous[non-woody}plants,regardless
11, of size,and woody plants less than 3.28 ft tall.
12- Woody vine—All woody vines greater than 3.28 ft in
=Total Cover height.
WOodv Vine Stratum (Plot size: }
1-
2-
3.
4• Hydrophytic
5 Vegetation
Present? Yes Nv
6-
=Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Eastern Mountains and Piedmont—Interim Version
US Army Corps of Engineers

SOIL Sampling Paint wa�,4)z
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
[inches) Color moist % Color_(moist)_ °k Tvne Lae Texture Remarks
�y
T C=Concentration,D=De letion,RM=Reduced Matrix,MS=Masked Sand Grains. 2Location- PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils':
_ Histosol(Al) f Dark Surface(S7) _ 2 cm Muck(A16)(MLRA 147)
_ Histic Epipedon(A2) f Polyvalue Below Surface(S8)(MLRA 147,148) — Coast Prairie Redox(A16)
_ Black Histic(A3) _ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
_ Hydrogen Sulfide(A4) _ Loamy Gleyed Matrix(F2) _ Piedmont Floodplain Soils(F19)
Stratified.Layers(A5) Depleted Matrix(F3) (MLRA 136,147)
— 2 cm Muck(Al0)(LRR N) _ Redox Dark Surface(F6) _ Red Parent Material(TF2)
Depleted Below Dark Surface(All 1) _ Depleted Dark Surface(F7) — Very Shallow Dark Surface(TF12)
— Thick Dark Surface(Al 2) _ Redox Depressions(F8) — Other(Explain in Remarks)
Sandy Mucky Mineral(51)[LRR N, _ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
Sandy Gleyed Matrix(S4) , Umbric Surfaoe(F13)(MLRA 136,122) 31ndicators of hydrophytic vegetation and
Sandy Redox(S5) _ Piedmont Floodplain Soils(F19)(MLRA 148) wetland hydrology must be present,
Stripped Matrix(S6) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Hydric Soil Present? Yes No
Depth(inches):
Remarks.
Eastern Mountains and Piedmont—Interim Version
US Army Corps of Engineers

656- jZZ
VV-e—+
WETLAND DETERMINATION DATA FORM—Eastern Mountains and Piedmont _ -7
Cit(Count : Sampling Date: f
ProjectJSite: Y y
.. i
Applicant/Owner: State: Sampling Point: f )
Investigator(s): Section,Township,Range:
Landform(hillslope,terrace,etc.): Local relief(Concave,Convex,none): Slope
Subregion(LRR or MLRA): Lat. J Long. Datum:
Sail Map Unit Name: NWi classification: r
Are climatic/hydrologic conditions on the site typical for this time of year- Yes ' No (If no,explain in Remarks.)
Are Vegetation ,Soil ,or Hydrology significantly disturbed? Are"Normal Circumstances"present? Yes No
Are Vegetation ,Soil ,or Hydrology naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS— Attach site map showing sampling point locations,transects, important features,etc.
Hydrophytic Vegetation Present? Yes No Is the Sampled Area
Hydric Soil Present? Yes No within a Wetland? Yes No
Wetland Hydrology Present? Yes No
Remarks:
HYDROLOGY
Wetland Hydrology Indicators: Secondary Indicators(minimum of two reouired)
Primary Indicators minimum of one is re uired•check all that apply) Surface Soil Cracks(136)
Surface Water(Al) , True Aquatic Plants(1314) = Sparsely Vegetated Concave Surface(B8)
' High Water Table(A2) , Hydrogen Sulfide Odor(Ci) - Drainage Pattems(B10)
Saturation 03) _ Oxidized Rhizospheres on Living Roots(C3) _ Moss Trim Lines(616)
_ Water Marks(81) _ Presence of Reduced Iron(C4) _ Dry-Season Water Table(02)
Sediment Deposits(B2) _ Recent Iron Reduction in Tilled Soils(C6) _ Crayfish Burrows(C8)
Drift Deposits(133) _ Thin Muck Surface(C7) , Saturation Visible on Aerial Imagery(C9)
Algal Mat or Crust(B4) _ Other(Explain in Remarks) _ Stunted or Stressed Plants(D1)
Iron Deposits(65) -Geomorphic Position(D2)
Inundation Visible on Aerial Imagery(137) Shallow Aquitard(D3)
Water-Stalned Leaves(B9) Microtopographic Relief(134)
Aquatic Fauna(1313) FAC-Neutral Test(D5)
Field Observations: y
Surface Water Present? Yes No Depth(inches):
r
Water Table Present? Yes No Depth(inches): "
Saturation Present? Yes No Depth(inches). Wetland Hydrology Present? Yes No
includes capillary fringe)
Describe Recorded Data{stream gauge,monitoring well,aerial photos,previous inspections],if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont—Interim Version

C56;Q7;?
VEGETATION (Four Strata)—Use scientific names of plants. Sampling Point:
Absolute Dominant Indicator Dominance Test worksheet:
Tree Stratum {Plot size: } %Cover Species? Status Number of Dominant Species
1 r J — That Are OBL,FACW,or FAC: (A)
2• I Total Number of Dominant
3 ;•L. cY s Species Across All Strata: (B)
4.
Percent of Dominant Species
5, That Are OBL,FACW,or FAG: (A/B)
6.
Prevalence Index worksheet:
7.
Total%Cover of: Multiply by: _
8.
=Total Cover OBL species x 1=
Sapling/Shrub Stratum (Plot size. ] FACW species x 2=
1 r FAG species x 3=
2 J FACU species x 4=
3 UPL species x 5=
4 Column Totals: (A) (B)
5.
Prevalence Index =61A=
6.
Hydrophytic Vegetation Indicators:
7.
_ 1-Rapid TesLIor H dry hyfi�Vegetatien
8' f�2-Dominance Test is>50%J
9- f 3=Prevalence Index is 3-0'
10. _ 4-Morphological Adaptations'(Provide supporting
=Total Cover data in Remarks or on a separate sheet)
Herb Stratum (Plot size: }
Problematic Hydrophytic Vegetation'(Explain)
1 —
2' Indicators of hydric soil and wetland hydrology must
3• be present,unless disturbed or problematic.
4• Definitions of Four Vegetation Strata:
5.
6 Tree—Woody plants,excluding vines,3 in.(7.6 cm)or
more in diameter at breast height(DBH),regardless of
7. height.
8. Sa pi i ng[Sh ru b—Woody plants,excluding vines,less
g- than 3 in-DBH and greater than 3-28 ft(1 m)tall-
10.
Herb—All herbaceous{non-woody}plants,regardless
11. of size,and woody plants less than 3.28 ft tall.
12,
Total Cover Woody vine—All woody vines greater than 3.28 ft in
Wood height-
Vine Stratum {Plot size: ]
1-
2.
3.
4. Hydrophytic
5, Vegetation
6 Present? Yes No
=Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
U5 Army Corps of Engineers Eastern Mountains and Piedmont—Interim Version

e5 z2-
SOIL Sampling Point: '
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inchesl Color(moist) % Color(moist) % Type Loc Texture Remarks
'Type: C=Concentration,D=De letion,RM=Reduced Matrix,MS=Masked Sand Grains. 2Location: Pt.=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils':
_ Histosol(Al) _ Dark Surface(S7) _ 2 cm Muck(A10)(MLRA 147)
_ Histic Epipedon(A2) _ Polyvalue Below Surface(S8)(MLRA 147,148) — Coast Prairie Redox(A16)
_ Black Histic(A3) _ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
_ Hydrogen Sulfide(A4) _ Loa My_Glieyed Matrix��2) _ Piedmont Floodplain Soils(F19)
_ Stratified Layers(A5) Depleted Matnk(�F ) i (MLRA 136,147)
_ 2 cm Muck(A10)(LRR N) RedoxDark-Sulffice(F6) — Red Parent Material(TF2)
_ Depleted Below Dark Surface(A11} _ Depleted Dark Surface(F7) _ Very Shallow Dark Surface(TF12)
_ Thick Dark Surface(Al 2) _ Redox Depressions(F8) _ Other(Explain in Remarks)
_ Sandy Mucky Mineral(S1)(LRR N, � Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
Sandy Gleyed Matrix(54) Umbric Surface(F13)(MLRA 136,122) 'Indicators of hydrophytic vegetation and
Sandy Redox(S5) _ Piedmont Floodplain Soils(F19)(MLRA 148) wetland hydrology must be present,
_ Stripped Matrix(S6) unless disturbed or problematic.
Restrictive Layer(if observed):
Type:
Depth(inches): Hydric Soil Present? Yes No
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont—Interim Version

r� WETLAND DETERMINATION DATA FORM--Eastern Mountains and Piedmont
Project/Site: L� � CitylCounty: 0,r5 YEA Sampling Date: —7 -Z 611
Applicant/Owner: �' State: ,�,C Sampling Point:
r— 7 i�n
Investigator(s): ` '' " Section,Township,Range:
Landform;(hillslo ,terrace,etc.): Local relief(concave,convex, one Slope{%]:
Subregion(LRR or MLRA): "' - 1 at f ' Long: J Datum: ©
Soil Map Unit Name: :� — NWI classification: -�
Are climatic 1 hydrologic conditions on the site typical for this time of year? Yes No (If no,explain in Remarks.) f
Are Vegetation Soil ,or Hydrology significantly disturbed? Are"Normal Circumstances"present? Yes No
Are Vegetation ,Soil ,or Hydrology naturally problematic? (If needed,explain any answers in Remarks.)
SUMMARY OF FINDINGS— Attach site map showing sampling point locations,transects, important features,etc.
Hydrophytic Vegetation Present? Yes X No Is the Sampled Area
Hydric Soil Present? Yes No :x: within a Wetland? Yes No
Wetland Hydrology Present? Yes No
Remarks:
HYDROLOGY
Wetland Hydrology Indicators: Seconds ry Indicators minimum of two reg uired
Prima ry Indicators minimum of Qne is rea uired check all that a I _ Surface Soil Cracks(136)
_ Surface Water(At) _ True Aquatic Plants(B14) _ Sparsely Vegetated Concave Surface(138)
_ High Water Table(A2) _ Hydrogen Sulfide Odor(GI) _ Drainage Patterns(BID)
_ Saturation(A3) Oxidized Rhizospheres on Living Roots(0) Mass Trim Lines(B16)
_ Water Marks(69) _ Presence of Reduced Iron(C4) Dry-Season Water Table(C2)
_ Sediment Deposits(B2) Recent Iron Reduction in Tilled Soils(C6) Crayfish Burrows(C8)
_ Drift Deposits(133) Thin Muck Surface(C7) Saturation Visible on Aerial Imagery(C9)
_ Algal Mat or Crust(B4) _ Other(Explain in Remarks) _ Stunted or Stressed Plants(D1}
_ Iron Deposits(135) _ Geomorphic Position(132)
Inundation Visible on Aerial Imagery(137) _ Shallow Aquitard(D3)
Water-Stained Leaves(69) Microtopographic Relief(134)
Aquatic Fauna(B13) _ FAG-Neutral Test(D5)
Field Observations.
Surface Water Present? Yes No Depth(inches):
Water Table Present? Yes No Depth(inches):
Saturation Present? Yes No Depth(inches): Wetland Hydrology Present? Yes No
(includes capillary fringe)
Describe Recorded Data(stream gauge,monitoring well,aerial photos,previous inspections),if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont—Interim Version

65�2z
VEGETATION (Four Strata)—Use scientific names of plants. Sampling Point: �!a�
Absolute Dominant Indicator Dominance Testworksheet:
Tree Stratum {Plot size: 0 } %Cover Species? Status Number of Dominant Species
1. %'-
That Are OBL,FACW,or FAG: (A)
2. i _ ,� �— ref�-
Total Number of Dominant
3, Species Across All Strata: (B)
4.
Percent of Dominant Species
5. That Are OBL,FACW,or FAC: {A/B}
6.
Prevalence Index worksheets
7.
Total%Cover of: Multiply by:
8.
Total Cover 081-species x 1-
Sapling/Shrub Stratum (Plot size: y } I FACW species x 2-
1 �;.. J FAG species x 3= _
2 FACU species x 4=
3 UPL species x 5=
¢ Column Totals: (A) (B)
5. Prevalence Index =BIA=
6.
Hydrophytic Vegetation Indicators:
7-
1-Rapid Test for Hydraphytic Vegetation
8. -
��2-l7vmihanoe Test is� °Ia
g' ~ 3-Prevalence Index is 53.0'
10' 4-Morphological Adaptations'(Provide supporting
=Total Cover data in Remarks or on a separate sheet)
Herb Stratum (Plot size: ] i
/ Problematic Hydrophytic Vegetation (Explain)
Indicators of hydric soil and wetland hydrology must
3. be present,unless disturbed or problematic.
4. Definitions of Four Vegetation Strata:
5.
Tree-Woody plants,excluding vines,3 in.(7.6 cm)or
6, more in diameter at breast height(DBH),regardless of
height.
8• SaplinglShruIn-Woody plants,excluding vines,less
g• than 3 in.GBH and greater than 3.28 ft(1 m)tall-
10- Herb-Ail herbaceous(non-woody)plants,regardless
11. of size,and woody plants less than 3.28 It tall.
12-
=Total Cover Woody vine-All woody vines greater than 3.28 ft in
height-
WoodyVine Stratum (Plot size: }
- .a
1. �l =
2.
3.
-
4,- Hydrophytic
5, Vegetation
6 Present? Yes No
Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont-Interim Version

SOIL Sampling Point:L.Lo
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
inches Color moist % Color(moist)_ % Type Lflc Texture Remarks
'Type: C=Conoentration,D=De letion,RM=Reduced Matrix,MS=Masked Sand Grains. 2L.ocation: PL=Pore Lining,M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils':
Histosol(Al) _ Dark Surface(S7) — 2 cm Muck(A10)(MLRA 147)
Histic Epipedon(A2) Polyvalue Below Surface(S8)(MLRA 147,148) _ Coast Prairie Redox(A16)
_ Black Histic(A3) _ Thin Dark Surface(S9)(MLRA 147,148) (MLRA 147,148)
_ Hydrogen Sulfide(A4) _ Loamy Gleyed Matrix(F2) _ Piedmont Floodplain Soils(F19)
_ Stratified Layers(A5) Depleted Matrix(F3) (ML.RA 136,147)
_ 2 cm Muck(A10)(LRR N) _ Redox Dark Surface(F6) _ Red Parent Material(TF2)
_ Depleted Below Dark Surface(A11) — Depleted Dark Surface(F7) _ Very Shallow Dark Surface(TF12)
_ Thick Dark Surface(Al2) T Redox Depressions(F8) _ Other(Explain in Remarks)
Sandy Mucky Mineral(S1)(LRR N, _ Iron-Manganese Masses(F12)(LRR N,
MLRA 147,148) MLRA 136)
_ Sandy Gleyed Matrix(S4) — Umbric Surface(F13)SMLRA 136,122) 3Indicators of hydrophytic vegetation and
_ Sandy Redox(S5) , Piedmont Floodplain Soils(F19)(WILRA 148) wetland hydrology must be present,
_ Stripped Matrix(SS) unless disturbed or problematic.
Restrictive Layer(if observed): v
Type /1
Depth[inches}: Hydric Soil Present? Yes No
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont—Interim Version