20200207 Ver 1__U5907_Potts-Sloan_PCN_Compiled_20200206_20200210

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW- Begin Date (Date Received):
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: TIP U-5907 Potts -Sloan Extension
2. Work Type: ❑Private ❑Institutional ❑✓ Government ❑ Commercial
3. Project Description / Purpose [PCN Form B3d and B3e]:
The North Carolina Department of Transportation (NC DOT) proposes to extend Potts Street to Sloan Street in the Town of Davidson,
Mecklenburg County (TIP U-5907). The purpose of this project is to provide an alternative route between N.C. 115 and Griffith Street
for multiple modes of transportation.
4. Property Owner / Applicant [PCN Form A3 or A41: NC DOT
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Chris Tinklenberg, PWS (Kimley-Horn)
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
Project area is located from Potts Street to Beaty Street. Project coordinates (Decimal Degrees):
35.502426 N,-80.850772 W
8. Project Location— Tax Parcel ID [PCN Form Bla]: Multiple - Linear Transportation project
9. Project Location — County [PCN Form A2b]: Mecklenburg
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Davidson
11. Project Information — Nearest Waterbody [PCN Form 132a]: Lake Norman
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: Upper Catawba (HUC 03050101)
Authorization: Section 10 ❑ Section 404 ✓❑
Regulatory Action Type:
Standard Permit
✓ Nationwide Permit # 14
Regional General Permit #
Jurisdictional Determination Request
Section 10 and 404 ❑
Pre -Application Request
Unauthorized Activity
Compliance
No Permit Required
Revised 20150602

STA�TEo,�
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
February 5, 2020
Ms. Nicholle Braspennickx
Asheville Regulatory Field Office
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801-5006
Re: Nationwide Permit #14 — NC DOT TIP# U-5907
Extension of Potts Street to Sloan Street
Davidson, Mecklenburg County, NC
Dear Ms. Braspennickx:
JAMES H. TROGDON, III
SECRETARY
NCDOT is submitting the attached PCN application for authorization under Nationwide Permit
(NWP) 14 for the proposed extension of Potts Street to connect to Sloan Street in the Town of
Davidson, Mecklenburg County, NC (NCDOT TIP# U-5907). The proposed extension will also
include a roundabout at the intersection of Sloan Street and Griffith Street. The following
information is enclosed:
• Pre -Construction Notification (PCN) Form
• Project Site Figures
• Preliminary Jurisdictional Determination
• NC Stream/Wetland Assessment Method Forms (NCSAM/NCWAM)
• Minimum Criteria Determination Checklist
• Permit Drawings
The proposed extension seeks to construct approximately 0.07-miles of new location roadway to
connect Potts Street to Sloan Street as well as a roundabout at the intersection of Sloan Street and
Griffith Street. The purpose of the project is to provide a contiguous north/south connector to
improve roadway network connectivity, create a safer route for local commuters, relieve traffic
congestion on N.C. 115 through the Town of Davidson, and provide for the continuous flow of
traffic along Sloan and Griffith Streets.
Water resources in the in the project area are located within the Upper Catawba River Basin. One
intermittent stream (SA), one perennial stream (SB), and one wetland (WA) were identified in the
project area. The proposed extension and roundabout will result in unavoidable impacts to 0.03-
acres of Wetland WA, 218 linear feet (LF) of Stream SA (UT to Lake Norman), and 13 LF of
Stream SB (UT to Lake Norman). Based on NCSAM and NCWAM quality assessments,
compensatory mitigation is proposed at 2:1 for unavoidable impacts to Wetland WA and Stream
SB. Compensatory mitigation is proposed at 1.5:1 for unavoidable impacts to Stream SA.
Mailing Address: Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fax: [phone] WEST MAIN STREET
HIGHWAY DIVISION 10 Customer Service: 1-877-368-4968 ALBEMARLE, NC 28001
716 WEST MAIN STREET
ALBEMARLE, NC 28001 Website: www.nedot.gov

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
TAMES H. TROGDON, III
SECRETARY
The extension of Potts Street was determined to have a "Conditional No Adverse Effect" on the
Davidson Historic District (NRHP). Additionally, the proposed roundabout at the intersection of
Griffith Street and Sloan Street would have an "Adverse Effect" on a structure to the Davidson
Historic District. Coordination is ongoing between NCDOT and the State Historic Preservation
Office (SHPO) to complete a Memorandum of Agreement (MOA).
Kristi Lynn Carpenter, NC Division of Water Resources, Transportation Permitting Unit and
Donna Hood, NC DWR Mooresville Regional Office, will review the project through the electronic
form (https://edocs.deq.nc.gov/Forms/Pre-Construction Notification_ Form). Please charge the
application fee of $570.00 to WBS element # 46452.1.1. Please forward comments directly to the
Corps with copy to Division 10 Environmental Officer.
Please feel free to contact me at [phone] if you have any questions or if additional
information is necessary.
Sincerely,
Larry Thompson, PWS, LSS
Division Environmental Officer
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
HIGHWAY DIVISION 10
716 WEST MAIN STREET
ALBEMARLE, NC 28001
Telephone: [phone]
Fax: [phone]
Customer Service: 1-877-368-4968
Website: www.ncdot.gov
Location:
716 WEST MAIN STREET
ALBEMARLE, NC 28001

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre -Construction Notification PCN Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1b.
Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1d.
Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
® Yes
❑ No
1g.
Is the project located in any of NC's twenty coastal counties? If yes, answer
1 h below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Potts -Sloan Extension
2b. County:
Mecklenburg
2c.
Nearest municipality / town:
Davidson
2d. Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state
project no:
7U-5907
3.
Owner Information
3a.
Name(s) on Recorded Deed:
NCDOT (Linear Transportation Easement)
3b.
Deed Book and Page No.
N/A
3c.
Responsible Party (for LLC if
applicable):
N/A
3d. Street address:
N/A
3e. City, state, zip:
N/A
3f.
Telephone no.:
N/A
3g.
Fax no.:
N/A
3h.
Email address:
N/A
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ® Other, specify: NCDOT
4b.
Name:
NCDOT- Division 10; Attn: Larry Thompson
4c.
Business name
(if applicable):
N/A
4d. Street address:
NCDOT Highway Division 10, 716 West Main Street
4e. City, state, zip:
Albemarle, NC 28001
4f.
Telephone no.:
704-983-4400
4g.
Fax no.:
704-982-3146
4h.
Email address:
[e-mail]
S.
Agent/Consultant Information (if applicable)
5a.
Name:
Chris Tinklenberg
5b.
Business name
(if applicable):
Kimley-Horn
5c.
Street address:
200 South Tryon Street, Suite 200
5d. City, state, zip:
Charlotte, NC 28202
5e. Telephone no.:
704-409-1802
5f.
Fax no.:
N/A
5g.
Email address:
[e-mail]
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
N/A
1 b. Site coordinates (in decimal degrees):
Latitude: 35.502426 Longitude: - 80.850772
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
44.4 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Lake Norman
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS-IV, B;CA
2c. River basin:
Catawba
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The project is located from Potts Street to Beaty Street in the Town of Davidson in Mecklenburg County. Land use within
the project area consists of single-family residences and commercial/retail properties. The property is bound to the west
by Lake Norman and Main Street to the east. The project vicinity is comprised of high -density residential areas and
commercial/retail land.
3b. List the total estimated acreage of all existing wetlands on the property:
0.03 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
675 linear feet
3d. Explain the purpose of the proposed project:
The purpose of this project is to add an alternative route between N.C. 115 and Griffith Street for multiple modes of
transportation.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project proposes to extend Potts Street north to connect with Sloan Street and construct a roundabout at the
intersection of Sloan Street and Griffith Street. Equipment typical of roadway construction would be used, including
cranes, track hoes, back hoes, graders, dump trucks, bulldozers, and pavers.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes ❑ No Unknown
project (including all prior phases) in the past?
Comments: SAW-2015-01444
4b. If the Corps made the jurisdictional determination, what type
®Preliminary El Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: Kimley-Horn
Name (if known): Chris Tinklenberg
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Kimley-Horn delineated the project area in October 2014. A Preliminary Jurisdictional Determination request of the
delineated project area has been included as part of this application.
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
N/A
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ❑ Yes ® No
6b. If yes, explain.
N/A
C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
® Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non-404, other)
(acres)
Temporary T
Site 1 (WA)
Fill
PFO
® Yes
® Corps
0.03
®P❑T
No
❑DWQ
_2g. Total wetland impacts
0.03
2h. Comments: Unavoidable impacts to wetlands will result from the proposed extension of Potts Street. Impacts to wetlands
will result from fill due to the installation of RCP.
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PCN Form — Version 1.3 December 10, 2008 Version

3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non-404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
Site 1 (SA)
Embankment
UT to Lake
❑ PER
® Corps
3
11
[IP ❑ T
Protection
Norman
® INT
❑ DWQ
Site 1 (SA)
Dewatering
UT to Lake
❑ PER
® Corps
3
7
❑ P ® T
Norman
® INT
❑ DWQ
Site 1 (SA)
Fill & Pipe
UT to Lake
❑ PER
® Corps
3
192
[IP ❑ T
Installation
Norman
® INT
❑ DWQ
Site 2 (SA)
Outlet Protection
UT to Lake
❑ PER
® Corps
3
15
® P ❑ T
Norman
® INT
❑ DWQ
Site 2 (SA)
Dewatering
UT to Lake
❑ PER
® Corps
3
10
❑ P ® T
Norman
❑ INT
❑ DWQ
Site 3 (SB)
Outlet Protection
UT to Lake
® PER
® Corps
6
10
® P ❑ T
Norman
❑ INT
❑ DWQ
Site 3 (SB)
Dewatering
UT to Lake
® PER
® Corps
6
5
❑ P ® T
Norman
❑ INT
❑ DWQ
Site 4 (SB)
Pipe Installation
UT to Lake
® PER
® Corps
6
3
® P ❑ T
Norman
❑ INT
❑ DWQ
Site 4 (SB)
Dewatering
UT to Lake
® PER
® Corps
6
10
❑ P ® T
Norman
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
263
3i. Comments: Unavoidable impacts to jurisdictional streams will result from the proposed extension of Potts Street and the
construction of the roundabout at the intersection of Sloan Street and Griffith Street. Impacts to streams will result from
embankment protection, outlet protection, and fill due to the installation of RCP.
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number—
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P❑T
02 ❑P❑T
4f. Total open water impacts
4g. Comments: No open water impacts will result from the proposed construction.
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
5f. Total
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5g. Comments: No ponds or lakes will be constructed as part of the proposed project.
5h. Is a dam high hazard permit required?
❑ Yes ®No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
❑ Neuse El Tar -Pamlico El Other:
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
re uired?
❑P❑T
❑Yes
❑ No
6h. Total buffer impacts
6i. Comments: No buffer impacts will result from the proposed construction.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Impacts to streams and wetlands within the project area have been avoided and minimized to the maximum extent practical
through design. Multiple alternatives were analyzed at the extension location; however, there is no alternative which results in
avoidance of SA and WA due to the location of the features on the landscape and the proposed roadway alignment necessary
to meet the project purpose. The roundabout was specifically aligned to avoid impacts to SB; however, minor impacts are
necessary to improve the existing drainage network.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Impacts to streams and wetlands within the corridor will be avoided and minimized to the extent practical throughout the
construction process. To avoid unnecessary impacts to streams within the project area, staging, storage, and construction
access will occur in upland areas where feasible. Silt fencing will be installed along the construction limits to ensure all equipment
and work stays within the permitted boundaries. Stormwater and erosion control measures will be utilized to avoid sedimentation
impacts to downstream waters and control runoff from the construction site.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
® Yes ❑ No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply):
® DWQ ® Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
®Payment to in -lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
® Yes ❑ No
4b. Stream mitigation requested:
220 linear feet
4c. If using stream mitigation, stream temperature:
® warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
0.03 acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments: Based on NCSAM and NCWAM quality assessments, compensatory mitigation is proposed at 2:1 for
unavoidable impacts to Wetland WA and Stream SB. Compensatory mitigation is proposed at 1.5:1 for unavoidable impacts
to Stream SA. Mitigation has been secured through the NCDMS ILF program and an approval letter has been attached.
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1a.
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
Comments: The project is located in the French Broad River basin and no NC
❑ Yes ❑ No
Riparian Buffer Protection Rules apply.
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
22.7%
2b.
Does this project require a Stormwater Management Plan?
® Yes ❑ No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The project plans to maintain existing drainage patterns to the extent practical. The
proposed drainage systems were
designed and sized with future development taken into account and the following items
were incorporated to minimize water
quality impacts: the alignment was designed to minimize wetland and stream crossing impacts, 2:1 slopes are going to be
utilized to reduce structure length, grassed swales will be implemented to the maximum extent practical, and open channel
designs with riprap on the banks will be implemented where practical to reduce jurisdictional
stream impacts.
❑ Certified Local Government
2e.
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
® DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this project?
Mecklenburg County
❑ Phase II
3b.
Which of the following locally -implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
® Water Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
® Yes ❑ No
attached?
4.
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a.
Which of the following state -implemented stormwater management programs apply
❑ ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
® Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
® Yes ❑ No
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a.
Does the project involve an expenditure of public (federal/state/local) funds or the
® Yes
❑ No
use of public (federal/state) land?
1 b.
If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
® Yes
❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c.
If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.)
® Yes
❑ No
Comments: A Minimum Criteria Determination Checklist has been prepared for the
proposed project and is attached.
2.
Violations (DWQ Requirement)
2a.
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes
® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
❑ Yes
® No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes
® No
additional development, which could impact nearby downstream water quality?
3b.
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
The project is designed to provide connectivity and to create a safer north/south route for local commuters. No additional
or cumulative impacts are anticipated due to the construction of the proposed project.
4.
Sewage Disposal (DWQ Requirement)
4a.
Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
No wastewater will be generated as a result of the proposed project.
Page 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
® Yes ❑ No
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
® Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The USFWS lists five federally protected species for Mecklenburg County: Northern long-eared bat (NLEB), Rusty -
patched bumble bee, Carolina heelsplitter, Michaux's sumac, Schweinitz's sunflower, and Smooth coneflower.
No effect was determined for Carolina heelsplitter, Michaux's sumac, Schweinitz's sunflower, and Smooth coneflower.
The proposed project determined "May Affect, Not Likely to Adversely Affect" the NLEB. USFWS does not require survey
for the Rusty -patched bumble bee and therefore no biological conclusion is determined.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
The NOAA Essential Fish Habitat Mapper was reviewed on January 8, 2020. No essential fish habitat was found within
the project area or within the vicinity of the project.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
® Yes ❑ No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
The North Carolina State Historic Preservation Office HPOWEB GIS Service (Accessed January 9, 2020) shows that the
proposed project intersects with the Davidson Historic District which is listed in the National Register of Historic Places
(NRHP). On July 2, 2018, NCDOT and the State Historic Preservation Officer (SHPO) determined that the proposed
extension of Potts Street through the Davidson Historic District would have a "Conditional No Adverse Effect." NCDOT
and SHPO also determined that the proposed roundabout at the intersection of Sloan Street and Griffith Street would
have an "Adverse Effect" on a structure to the Davidson Historic District. NCDOT is coordinating with SHPO and
consulting parties to complete a Memorandum of Agreement (MOA).
Roosevelt Wilson Park, a Section 4(f) resource is located along the proposed multi -use trail connection of the project. In
July 2018, the Town of Davidson determined the proposed project will not adversely affect the activities, features, or
attributes that qualify the property for protection under Section 4(f).
Additionally, Roosevelt Wilson Park is protected under LWCF/Section 6(f) and PARTF regulations. Initially, the proposed
design of the project had potential impacts on the Park. In December 2019, NCDOT revised the proposed designs of the
project to avoid a permanent conversion of any Section 6(f) or PARTF protected property. NC Parks and Recreation
concurred with the revised project design which will avoid the conversion of temporary non -conforming use of the park
property.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? The FEMA Digital Flood Insurance Rate Map (DFIRM)
Panel 3710464400K (effective March 2, 2009).
Larry Thompson, PWS, LSS
Applicant/Agent's Printed Name
2/5/2020
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

FIGURES

i Miles
0 0.25 0.5
Mecklenburg
County
tkORTff Figure 1
Project Study Area Mecklenburg County Vicinity Map
Streams Town of Cornelius TIP U-5907
Potts Street Extension
Lakes and Ponds Town of Davidson Mecklenburg County, NC
OF TVk

Ilk
' .• t1
t
mom _ `M
1- •
• • • ~ r
•
■ 6410
• •• -
• * . •
s •
Legend '
1 r
Feet
a Project Study Area �; % 0 500 1,000
NORTH
Figure 2
USGS Topographic Map
TIP U-5907
Potts Street Extension
y9T�FNr HyQOQ�< Mecklenburg County, NC
OF 'TNM

�Q�aro' Dr � '•
Jib.t N
Griffith St
Ot
10011
41r` �' 1
e U' Dep�t'St
v
SRO 0
O
--. Jetton
St f
M.
Catawba F ` •�,
C3-
/ CO
Cathey St
• • =
Project•
Streams
Wetlands
A 400 :��
7 i7

m
Li
w
Fee
500 1,000
CeB2 N
00
kD
WkD
-- _
if
I
C U '14 4
�k
u
�T
Legend
71, 'M
Project Study Area
U-5907 Hydric Soil Table
Map Unit
Map Unit Name
Hydric
CeB2
Cecil sandy clay loam, 2 to 8 percent slopes, moderately eroded
No
CuB
Cecil -Urban land complex, 2 to 8 percent slopes
No
EnB
Enon sandy loam, 2 to 8 percent slopes
No
WkB
Wilkes loam, 4to 8 percent slopes
No
WkD
Wilkes loam, 8to 15 percent slopes
No
ME
Wilkes loam, IS to 2S percent slopes
No
Figure 4
NRCS Soil Survey Map (1980)
TIP U-5907
Potts Street Extension
y9T�FNr �SQ�Q~e Mecklenburg County, NC
OF TPP

PRELIMINARY JURISDICTIONAL
DETERMINATION (PJD)

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action I.D.: SAW-2015-01444 County: Mecklenburg, U.S.G.S. Quad: Mooresville
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner/Agent: Doug Wright, Town Of Davidson
Address: 216 South Main Street Davidson, North Carolina 28036
Telephone No.: 704 940 9625
Property description:
Size (acres): 44.4 acres
Nearest Town: Davidson
Nearest Waterway: South Prong West Branch Rocky River River Basin: Upper Catawba
Coordinates: 35.502426,-80.850772 Hydrologic Unit Code: 03050101
Location Description: The proposed project consists of roadway corridor improvements along a combination of Beaty St.,
Sloan St., and Potts St., in the town of Davidson, Mecklenburg County, NC
Indicate Which of the Following Apply:
A. Preliminary Determination
X Based on preliminary information, there may be waters and wetlands on the above described property. We strongly
suggest you have this property inspected to determine the extent of Department of the Army (DA) jurisdiction. To be
considered final, a jurisdictional determination must be verified by the Corps. This preliminary determination is not an
appealable action under the Regulatory Program Administrative Appeal Process ( Reference 33 CFR Part 331). ). If you
wish, you may request an approved JD (which may be appealed), by contacting the Corps district for further instruction.
Also, you may provide new information for further consideration by the Corps to reevaluate the JD.
B. Approved Determination
There are Navigable Waters of the United States within the above described property subject to the permit requirements of
Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law or
our published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
_ There are waters and wetlands on the above described property subject to the permit requirements of Section 404 of the
Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
We strongly suggest you have the waters and wetlands on your property delineated. Due to the size of your property
and/or our present workload, the Corps may not be able to accomplish this wetland delineation in a timely manner. For a
more timely delineation, you may wish to obtain a consultant. To be considered final, any delineation must be verified by
the Corps.
The waters and wetlands on your property have been delineated and the delineation has been verified by the Corps. We
strongly suggest you have this delineation surveyed. Upon completion, this survey should be reviewed and verified by the
Corps. Once verified, this survey will provide an accurate depiction of all areas subject to CWA jurisdiction on your
property which, provided there is no change in the law or our published regulations, may be relied upon for a period not to
exceed five years.
_ The waters and wetlands have been delineated and surveyed and are accurately depicted on the plat signed by the Corps
Regulatory Official identified below on . Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
There are no waters of the U.S., to include wetlands, present on the above described property which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.

Action Id.: SAW-2015-01444
Placement of dredged or fill material within waters of the US and/or wetlands without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). If you have any questions regarding this
determination and/or the Corps regulatory program, please contact William Elliott at 828-271-7980.
C. Basis For Determination
The site contains wetlands as determined by the 1987 Corps of Engineers Wetland Delineation Manual and the Interim
Regional Supplement to the Corps of Engineers Wetlands Delineation Manual: Eastern Mountain andPiedmont Region. These
wetlands are adjacent to stream channels located on the property that exhibit indicators of ordinary high water marks. The
stream channel on the property is an unnamed tributary to South Prong West Branch Rocky River which flows into the Upper
Catawba River.
D. Remarks: Jurisdictional "Waters of the US" have been identified on this property as depicted
by submitted Jurisdictional Request Package on file.
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the
particular site identified in this request. The delineation/determination 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 request a certified wetland determination from the local office of the Natural Resources
Conservation Service, prior to starting work.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in
B. above)
Attached to this verification is an approved jurisdictional determination. If you are not in agreement with that approved
jurisdictional determination, you can make an administrative appeal under 33 CFR 331. Enclosed you will find a request for
appeal (RFA) form. If you request to appeal this determination you must submit a completed RFA form to the following
address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room 1OM15
Atlanta, Georgia 30303-8801
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for
appeal under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP.
Should you decide to submit an RFA form, it must be received at the above address within 60 days of the issue date below.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence.
r.
Corps Regulatory Official: William Elliott
Issue Date: August 11, 2015 Expiration Date: August 10, 2020
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to
do so, please complete the Customer Satisfaction Survey located at our website at http://per2.nmT.usace.apny.mil/surve.
to complete the survey online.
2

CF. Chris Tinklenberg, 2000 South Boulevard Suite 440, Charlotte, NC 28203-5047

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS SS P- D Al
REQUEST FOR APPEAL
Applicant: Doug Wright, Town Of Davidson
File Number: SAW-2015-
Date: August 11,
01444
2015
Attached is:
See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission)
A
PROFFERED PERMIT (Standard Permit or Letter of permission)
B
PERMIT DENIAL
C
APPROVED JURISDICTIONAL DETERMINATION
D
X
PRELIMINARY JURISDICTIONAL DETERMINATION
E
SECTION I -' The following identifies your rights and options regarding an administrative appeal of the above
decision. Additional information may be found at
http://www.usace.army.iiiilJCECW/Pages/reg_jnaterials.aspx or Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for fmal
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights
to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request that
the permit be modified accordingly. You must complete Section H of this form and return the form to the district engineer.
Your objections must be received by the district engineer within 60 days of the date of this notice, or you will forfeit your right
to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your objections and may: (a)
modify the permit to address all of your concerns, (b) modify the permit to address some of your objections, or (c) not modify
the permit having determined that the permit should be issued as previously written. After evaluating your objections, the
district engineer will send you a proffered permit for your reconsideration, as indicated in Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights
to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein, you
may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of this
form and sending the form to the division engineer. This form must be received by the division engineer within 60 days of the
date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process
by completing Section H of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or
provide new information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers Administrative
Appeal Process by completing Section II of this form and sending the form to the division engineer. This form must be received
by the division engineer within 60 days of the date of this notice.

E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps
regarding the preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an
approved JD (which may be appealed), by contacting the Corps district for further instruction. Also you may
provide new information for further consideration by the Corps to reevaluate the JD.
SECTION II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an
initial proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons
or objections are addressed in the administrative record
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record. However,
you may provide additional information to clarify the location of information that is already in the administrative record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the appeal
If you only have questions regarding the appeal process you may
process you may contact:
also contact:
William Elliott, Project Manager
Mr. Jason Steele, Administrative Appeal Review Officer
USAGE, Asheville Regulatory Field Office
CESAD-PDO
151 Patton Ave
U.S. Army Corps of Engineers, South Atlantic Division
RM 208
60 Forsyth Street, Room 10M15
Asheville, NC 28801
Atlanta, Georgia 30303-8801
828-271-7980
Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the opportunity to participate in all site investigations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: William Elliott, 69 Darlington Avenue, Wilmington,
North Carolina 28403
For Permit denials, Proffered Permits and approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele,
Administrative Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]
5

ATTACHMENT A
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):A w G // , 19- ©/ S
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
Kimley-Horn ATTN: Chris Tinklenberg on behalf of the Town of Davidson
2000 South Boulevard Suite 440; Charlotte, NC 28203-5047
C. DISTRICT OFFICE, FIL NAME, AND NUMBER:
l'>� S -96-- _ 7S-YZ©1,A
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES AT DIFFERENT
SITES)
State: NC County/parish/borough: Mecklenburg County City: Davidson
Center coordinates of site (lat/long in degree decimal format):
Lat. 35.502426 °N; Long. -80.850772
Universal Transverse Mercator: 17
Name of nearest waterbody: Lake Norman
ow.
Identify (estimate) amount of waters in the review area:
Non -wetland waters:
1,165' linear feet: 2-6' width (ft) and/or NSA acres.
Cowardln Class: Riverine
Stream Flow: Intermittent (S2), Perennial (S1,
Wetlands:0.03 acres.
Cowardin Class: Palustrine
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal: N/A
Non -Tidal: N/A
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):
0 Maps, plans, plots or plat submitted by or on behalf of the
applicant/consultant: Kimley-Horn
❑✓ Data sheets prepared/submitted by or on behalf of the
appl*nt/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: Mooresville and Cornelius Quads(124k)
❑✓ USDA Natural Resources Conservation Service Soil Survey.
Citation: Mecklenburg County (1980)
❑ 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): Mecklenburg Aerial (5/23/2014) or
❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
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.

This preliminary JD finds that there "maybe" 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 by the Corps and should not be relied upon for
later iurisdictional determinations.
2cZx
Signature and date of
Regulatory Project Manager
(REQUIRED)
ff� �i, a oil
DlgWly signed by
[e-mail]
DN: W= hris.dnWenbe.g®klmieyh=xorn
net.: 2015.03.1213:48:30-04'00'
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining
the signature is impracticable)
rd

Estimated
Site
Latitude
Longitude
Cowardin Class
amount of
aquatic
Class of aquatic
number
resource
resource in
review area
S1
35.508285
-80.847237
Riverine
234 linear feet
non -section 10 —
non -tidal
S2
35.503069
-80.853212
Riverine
145 linear feet
non -section 10 —
non -tidal
S3
35.499662
-80.851772
Riverine
786 linear feet
non -section 10 —
non -tidal
W1
35.499664
-80.851756 1
Palustrine
0.03 acres
non -section 10 —
wetland

NC STREAM ASSESSMENT METHOD
FORMS & NC WETLAND ASSESSMENT
METHOD FORMS

user manuai version c.-i
USACE AID #: NCDWR #:
INSTRUCTIONS: Attach a sketch of the assessment area and photographs. Attach a copy of the USGS 7.5-minute topographic
quadrangle, and circle the location of the stream reach under evaluation. If multiple stream reaches will be evaluated on the same
property, identify and number all reaches on the attached map, and include a separate form for each reach. See the NC SAM User
Manual for detailed descriptions and explanations of requested information. Record in the "Notes/Sketch" section if any supplementary
measurements were performed. See the NC SAM User Manual for examples of additional measurements that may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT / SITE INFORMATION:
1. Project name (if any): U-5907 Potts -Sloan Ext 2. Date of evaluation: August 27, 2015
3. Applicantlowner name: NCDOT 4. Assessor name/organization: C. Tinklenberg/Kimley-Horn
5. County: Mecklenburg 6. Nearest named water body
7. River Basin: Catawba on USGS 7.5-minute quad: Lake Norman
8. Site coordinates (decimal degrees, at lower end of assessment reach): 35.499813,-80.851910
STREAM INFORMATION: (depth and width can be approximations)
9. Site number (show on attached map): SA 10. Length of assessment reach evaluated (feet): -150
11. Channel depth from bed (in riffle, if present) to top of bank (feet): 0.5 r Unable to assess channel depth.
12. Channel width at top of bank (feet): 8- 13. Is assessment reach a swamp stream? f Yes f No
14. Feature type: C+` Perennial flow r Intermittent flow f Tidal Marsh Stream
STREAM RATING INFORMATION:
15. NC SAM Zone: f Mountains (M) f• Piedmont (P) f Inner Coastal Plain (1) r Outer Coastal Plain (0)
16. Estimated geomorphic \ /
valley shape (skip for f a �V- f• b
Tidal Marsh Stream): (more sinuous stream, flatter valley slope) (less sinuous stream, steeper valley slope)
17. Watershed size: (skip C•' Size 1 (< 0.1 mI') C' Size 2 (0.1 to < 0.5 mi`) C Size 3 (0.5 to < 5 mV) C Size 4 (>_ 5 mil)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION:
18. Were regulatory considerations evaluated? C• Yes C No If Yes, check all that appy to the assessment area.
f Section 10 water f Classified Trout Waters f Water Supply Watershed ( C I r II C III r Iv C V)
r Essential Fish Habitat r Primary Nursery Area r High Quality Waters/Outstanding Resource Waters
r Publicly owned property r NCDWR riparian buffer rule in effect r Nutrient Sensitive Waters
r Anadromous fish r 303(d) List r CAMA Area of Environmental Concern (AEC)
r Documented presence of a federal and/or state listed protected species within the assessment area.
List species:
f Designated Critical Habitat (list species):
19. Are additional stream information/supplementary measurements included in "Notes/Sketch" section or attached? r Yes No
1. Channel Water - assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
C• A Water throughout assessment reach.
C B No flow, water in pools only.
C C No water in assessment reach.
2. Evidence of Flow Restriction - assessment reach metric
C A At least 10% of assessment reach in -stream habitat or riffle -pool sequence is adversely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes or ponded water or impounded on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates).
C• B Not A
3. Feature Pattern - assessment reach metric
C A A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
C• B Not A.
4. Feature Longitudinal Profile - assessment reach metric
C• A Majority of assessment reach has a substantially altered stream profile (examples: channel down -cutting, existing damming,
over widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of
these disturbances).
C B Not A
5. Signs of Active Instability - assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
active bank failure, active channel down -cutting (head -cut), active widening, and artificial hardening (such as concrete, gabion, rip -rap).
r A < 10% of channel unstable
C• B 10 to 25% of channel unstable
C C > 25% of channel unstable
6. Streamside Area Interaction - streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RIB
C A r A Little or no evidence of conditions that adversely affect reference interaction
C• B C+` B Moderate evidence of conditions (examples: berms, levees, down -cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of flood flows through streamside area,
leaky or intermittent bulkheads, causeways with floodplain constriction, minor ditching [including mosquito ditching])
C C r C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision,
disruption of flood flows through streamside area] or too much floodplain/intertidal zone access [examples:
impoundments, intensive mosquito ditching]) or floodplain/intertidal zone unnaturally absent or assessment reach is a
man-made feature on an interstream divide
7. Water Quality Stressors -assessment reach/intertidal zone metric

Check all that apply.
F A Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
F B Excessive sedimentation (burying of stream features or intertidal zone)
F C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
F D Odor (not including natural sulfide odors)
r E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in the "Notes/Sketch"
section.
F F Livestock with access to stream or intertidal zone
r G Excessive algae in stream or intertidal zone
F H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc.)
r 1 Other: Trash/Debris Input (explain in "Notes/Sketch" section)
F- J Little to 'no stressors
8, Recent Weather —watershed metric
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a
drought.
r A Drought; conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
r B Drought conditions and rainfall exceeding 1 inch within the last 48 hours
ro C No drought conditions
g Large or Dangerous Stream — assessment reach metric
r Yes G No Is stream is too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural In -stream Habitat Types — assessment reach metric
10a. r* Yes (- No Degraded in -stream habitat over majority of the assessment reach (examples of stressors include excessive
sedimentation, mining, excavation, in -stream hardening [for example, rip -rap], recent dredging, and snagging)
(evaluate for size 4 Coastal Plain streams only, then skip to Metric 12)
10b. Check all that occur (occurs if > 5% coverage of assessment reach) (skip for Size 4 Coastal Plain streams)
r A Multiple aquatic macrophytes and aquatic mosses @ w r F 5% oysters or other natural hard bottoms
(include liverworts, lichens, and algal mats) F_ m f G Submerged aquatic vegetation
F_ B Multiple sticks and/or leaf packs and/or emergent o r H Low -tide refugia (pools)
vegetation x L o r I Sand bottom
f C Multiple snags and logs (including lap trees) 12
r Co f J 5% vertical bank along the marsh
D 5% undercut banks and/or root mats and/or roots 02 r K Little or no habitat
in banks extend to the normal wetted perimeter
f E Little or no habitat
`"**"'""`•..REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS***• � �'• �'• '•*•
11. Bedform and Substrate —assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
11 a. (—Yes 6— No Is assessment reach in a natural sand -bed stream? (skip for Coastal Plain streams)
11 b. Bedform evaluated. Check the appropriate box(es).
F A Riffle -run section (evaluate 11 c)
F B Pool -glide section (evaluate 11d)
1`7 C Natural bedform absent (skip to Metric 12, Aquatic Life)
11 c. In riffles sections, check all that occur below the normal wetted perimeter of the assessment reach — whether or not submerged.
Check at least one box in each row (skip for Size 4 Coastal Plain Streams and Tidal Marsh Streams). Not Present (NP) _
absent, Rare (R) = present but < 10%, Common (C) _ > 10-40%, Abundant (A) _ > 40-70%, Predominant (P) _ > 70%. Cumulative
percentages should not exceed 100% for each assessment reach.
NP R C A P
r r r r r Bedrock/saprolite
r r r r r Boulder (256 — 4096 mm)
r r r r r Cobble (64 — 256 mm)
r r r r r Gravel (2 — 64 mm)
r r r r r Sand (.062 — 2 mm)
r r r r r Silt/clay (< 0.062 mm)
r r r r r Detritus
r r r r r Artificial (rip -rap, concrete, etc.)
11 d. r Yes r No Are pools filled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
12. Aquatic Life — assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
12a. t- Yes (— No Was an in -stream aquatic life assessment performed as described in the User Manual?
If No, select one of the following reasons and skip to Metric 13. rNo Water r Other:
12b. r Yes 6— No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check
all that apply. If No, skip to Metric 13.
1 >1 Numbers over columns refer to "individuals" for size 1 and 2 streams and "taxa" for size 3 and 4 streams.
r r Adult frogs
r r Aquatic reptiles
r r Aquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
f r Beetles (including water pennies)
F r Caddisfly larvae (Trichoptera [T])
F r Asian clam (Corbicula )
F r Crustacean (isopod/amphipod/crayfish/shrimp)
r r Damselfly and dragonfly larvae
F r Dipterans (true flies)
F r Mayfly larvae (Ephemeroptera [E])
F r Megaloptera (alderfly, fishfly, dobsonfly larvae)
F r Midges/mosquito larvae
F r Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea)
F r Mussels/Clams (not Corbicula )

F r Other fish
F r Salamanders/tadpoles
F r Snails
F r Stonefly larvae (Plecoptera [P])
F r Tipulid larvae
F r Worms/leeches
13. Streamside Area Ground Surface Condition — streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB). Consider storage capacity with regard to both overbank flow and
upland runoff.
LB RB
r A r A Little or no alteration to water storage capacity over a majority of the streamside area
r B r B Moderate alteration to water storage capacity over a majority of the streamside area
r C r C Severe alteration to water storage capacity over a majority of the streamside area (examples include: ditches, fill,
soil, compaction, livestock disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area Water Storage — streamside area metric (skip for Size 1 streams, Tidal Marsh Streams, and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
rA r A Majority of streamside area with depressions able to pond water >_ 6 inches deep
rB r B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
r C r C Majority of streamside area with depressions able to pond water < 3 inches deep
15. Wetland Presence — streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB). Do not consider wetlands outside of the streamside area or within the
normal wetted perimeter of assessment reach.
LB RB
r Y r Y Are wetlands present in the streamside area?
r• N r- N
16. Baseflow Contributors — assessment reach metric (skip for size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
F A Streams and/or springs (jurisdictional discharges)
F B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
F C Obstruction that passes some flow during low -flow periods within assessment area (beaver dam, bottom -release dam)
F D Evidence of bank seepage or sweating (iron oxidizing bacteria in water indicates seepage)
r E Stream bed or bank soil reduced (dig through deposited sediment if present)
F F None of the above
17. Baseflow Detractors — assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
F A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
F B Obstruction not passing flow during low flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
F7 C Urban stream (>_ 24% impervious surface for watershed)
F D Evidence that the stream -side area has been modified resulting in accelerated drainage into the assessment reach
F E Assessment reach relocated to valley edge
F F None of the above
18. Shading — assessment reach metric (skip for Tidal Marsh Streams)
Consider aspect. Consider "leaf -on" condition.
r• A Stream shading is appropriate for stream category (may include gaps associated with natural processes)
rB Degraded (example: scattered trees)
r C Stream shading is gone or largely absent
19. Buffer Width — streamside area metric (skip for Tidal Marsh Streams)
Consider "vegetated buffer" and "wooded buffer" separately for left bank (LB) and right bank (RB) starting at the top
of bank out to the first break.
Vegetated Wooded
LB RB LB RB
r• A r A rA r A i 100-feet wide or extends to the edge of the watershed
rB r B r• B r B From 50 to < 100-feet wide
r C r C r C r C From 30 to < 50-feet wide
r D r- D r D r- D From 10 to < 30-feet wide
r E r E r E r E < 10-feet wide or no trees
20. Buffer Structure — streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Vegetated" Buffer Width).
LB RB
rA rA Mature forest
r• B r• B Non -mature woody vegetation or modified vegetation structure
r C r C Herbaceous vegetation with or without a strip of trees < 10 feet wide
r D r D Maintained shrubs
rE rE Little or no vegetation
21. Buffer Stressors — streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB). Indicate if listed stressor abuts stream (Abuts), does not abut but
is within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If none of the following stressors occurs on either bank, check here and skip to Metric 22: r
Abuts < 30 feet 30-50 feet
LB RB LB RB LB RB
rA r A rA r A rA r A Row crops
r B r B r B r B r B r B Maintained turf
r C r C r C r C r C r C Pasture (no livestock)/commercial horticulture
r D r D r D r D r D r D Pasture (active livestock use)

22. Stem Density — streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Wooded" Buffer Width).
LB RB
r A r A Medium to high stem density
r• B r• B Low stem density
r C r C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer— streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10-feet wide.
LB RB
rA rA The total length of buffer breaks is < 25 percent.
r• B r•B The total length of buffer breaks is between 25 and 50 percent.
r C r C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition — First 100 feet of streamside area metric (skip for Tidal Marsh Streams)
Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contributes
to assessment reach habitat.
LB RB
rA rA Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native
species, with non-native invasive species absent or sparse.
r• B r•B Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear -cutting or clearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
r C r C Vegetation is severely disturbed in terms of species diversity or proportions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non -characteristic species or communities inappropriately composed of a single species or no vegetation.
25. Conductivity— assessment reach metric (skip for all Coastal Plain streams)
25a. r Yes r• No Was a conductivity measurement recorded?
If No, select one of the following reasons. rNo Water r Other:
251b. Check the box corresponding to the conductivity measurement (units of microsiemens per centimeter).
rA <46 r B 46 to < 67 r C 67 to < 79 r D 79 to < 230 r E >> 230

NC SAM Stream Rating Sheet
Accompanies User Manual Version 2.1
Stream Site Name U-5907 Potts -Sloan Ext
Stream Category Pbl
Notes of Field Assessment Form (Y/N)
Presence of regulatory considerations (Y/N)
Additional stream information/supplementary measurements included (Y/N)
NC SAM feature type (perennial, intermittent, Tidal Marsh Stream)
Function Class Rating Summary
Date of Evaluation August 27, 2015
Assessor Name/Organization Tinklenberg/Kimley-Horr
NO
NO
Perennial
USACE/ NCDWR
All Streams Intermittent
(1) Hydrology LOW
(2) Baseflow MEDIUM
(2) Flood Flow LOW
(3) Streamside Area Attenuation LOW
(4) Floodplain Access MEDIUM
(4) Wooded Riparian Buffer LOW
(4) Microtopography NA
(3) Stream Stability LOW
(4) Channel Stability MEDIUM
(4) Sediment Transport LOW
(4) Stream Geomorphology MEDIUM
(2) Stream/Intertidal Zone Interaction NA
(2) Longitudinal Tidal Flow NA
(2) Tidal Marsh Stream Stability NA
(3) Tidal Marsh Channel Stability NA
(3) Tidal Marsh Stream Geomorphology NA
(1) Water Quality LOW
(2) Baseflow MEDIUM
(2) Streamside Area Vegetation MEDIUM
(3) Upland Pollutant Filtration LOW
(3) Thermoregulation HIGH
(2) Indicators of Stressors YES
(2) Aquatic Life Tolerance LOW
(2) Intertidal Zone Filtration NA
(1) Habitat MEDIUM
(2) In -stream Habitat LOW
(3) Baseflow MEDIUM
(3) Substrate LOW
(3) Stream Stability MEDIUM
(3) In -stream Habitat LOW
(2) Stream -side Habitat HIGH
(3) Stream -side Habitat HIGH
(3) Thermoregulation HIGH
(2) Tidal Marsh In -stream Habitat NA
(3) Flow Restriction NA
(3) Tidal Marsh Stream Stability NA
(4) Tidal Marsh Channel Stability NA
(4) Tidal Marsh Stream Geomorphology NA
(3) Tidal Marsh In -stream Habitat NA
(2) Intertidal Zone Habitat NA
Overall LOW

user manual version z.i
USACE AID #: NCDWR #:
INSTRUCTIONS: Attach a sketch of the assessment area and photographs. Attach a copy of the USGS 7.5-minute topographic
quadrangle, and circle the location of the stream reach under evaluation. If multiple stream reaches will be evaluated on the same
property, identify and number all reaches on the attached map, and include a separate form for each reach. See the NC SAM User
Manual for detailed descriptions and explanations of requested information. Record in the "Notes/Sketch" section if any supplementary
measurements were performed. See the NC SAM User Manual for examples of additional measurements that may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT / SITE INFORMATION:
1. Project name (if any): U-5907 Potts -Sloan Ext 2. Date of evaluation: August 27, 2015
3. Applicant/owner name: NCDOT 4. Assessor name/organization: C. Tinklenberg/Kimley-Horn
5. County: Mecklenburg 6. Nearest named water body
7. River Basin: Catawba on USGS 7.5-minute quad: Lake Norman
8. Site coordinates (decimal degrees, at lower end of assessment reach): 35.499813,-80.851910
STREAM INFORMATION: (depth and width can be approximations)
9. Site number (show on attached map): SB 10. Length of assessment reach evaluated (feet): -100
11. Channel depth from bed (in riffle, if present) to top of bank (feet): 3' F Unable to assess channel depth.
12. Channel width at top of bank (feet): 5' 13. Is assessment reach a swamp stream? Yes f' No
14. Feature type: f7 Perennial flow C' Intermittent flow Tidal Marsh Stream
STREAM RATING INFORMATION:
15. NC SAM Zone: C' Mountains (M) Piedmont (P) Inner Coastal Plain (1) Outer Coastal Plain (0)
16. Estimated geomorphic i
valley shape (skip for t a
Tidal Marsh Stream): (more sinuous stream, flatter valley slope) (less sinuous stream, steeper valley slope)
17. Watershed size: (skip C• Size 1 (< 0.1 mi) C' Size 2 (0.1 to < 0.5 mi) C' Size 3 (0.5 to < 5 mil) C' Size 4 (>_ 5 mil)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION:
18. Were regulatory considerations evaluated? t: Yes C' No If Yes, check all that appy to the assessment area.
F Section 10 water F Classified Trout Waters V1 Water Supply Watershed ( C' I f' II f' III C: IV
F Essential Fish Habitat F Primary Nursery Area F High Quality Waters/Outstanding Resource Waters
F Publicly owned property F NCDWR riparian buffer rule in effect F Nutrient Sensitive Waters
F_ Anadromous fish F 303(d) List F CAMA Area of Environmental Concern (AEC)
F Documented presence of a federal and/or state listed protected species within the assessment area.
List species:
F Designated Critical Habitat (list species):
1. Channel Water - assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
(: A Water throughout assessment reach.
B No flow, water in pools only.
C No water in assessment reach.
2. Evidence of Flow Restriction - assessment reach metric
A At least 10% of assessment reach in -stream habitat or riffle -pool sequence is adversely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes or ponded water or impounded on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates).
B Not A
3. Feature Pattern- assessment reach metric
f: A A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
B Not A.
4. Feature Longitudinal Profile- assessment reach metric
A Majority of assessment reach has a substantially altered stream profile (examples: channel down -cutting, existing damming,
over widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of
these disturbances).
(: B Not A
5. Signs of Active Instability - assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
active bank failure, active channel down -cutting (head -cut), active widening, and artificial hardening (such as concrete, gabion, rip -rap).
t A < 10% of channel unstable
B 10 to 25% of channel unstable
C' C > 25% of channel unstable
6. Streamside Area Interaction - streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RB
A �' A Little or no evidence of conditions that adversely affect reference interaction
t: B t: B Moderate evidence of conditions (examples: berms, levees, down -cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of flood flows through streamside area,
leaky or intermittent bulkheads, causeways with floodplain constriction, minor ditching [including mosquito ditching])
C �' C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision,
disruption of flood flows through streamside area] or too much floodplain/intertidal zone access [examples:
impoundments, intensive mosquito ditching]) or floodplain/intertidal zone unnaturally absent or assessment reach is a
man-made feature on an interstream divide

7. Water Quality Stressors - assessment reach/intertidal zone metric
Check all that apply.
F A Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
FIB Excessive sedimentation (burying of stream features or intertidal zone)
F C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
F D Odor (not including natural sulfide odors)
F E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in the "Notes/Sketch"
section.
F F Livestock with access to stream or intertidal zone
F G Excessive algae in stream or intertidal zone
F H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc.)
V I Other: Trash/Debris Input (explain in "Notes/Sketch" section)
F J Little to no stressors
8. Recent Weather -watershed metric
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a
drought.
A Drought conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
B Drought conditions and rainfall exceeding 1 inch within the last 48 hours
C No drought conditions
9 Large or Dangerous Stream - assessment reach metric
(- Yes t4 No Is stream is too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural In -stream Habitat Types - assessment reach metric
10a. C: Yes f' No Degraded in -stream habitat over majority of the assessment reach (examples of stressors include excessive
sedimentation, mining, excavation, in -stream hardening [for example, rip -rap], recent dredging, and snagging)
(evaluate for size 4 Coastal Plain streams only, then skip to Metric 12)
10b. Check all that occur (occurs if > 5% coverage of assessment reach) (skip for Size 4 Coastal Plain streams)
F A Multiple aquatic macrophytes and aquatic mosses m N F F 5% oysters or other natural hard bottoms
(include liverworts, lichens, and algal mats) F m F G Submerged aquatic vegetation
F B Multiple sticks and/or leaf packs and/or emergent o CO H Low -tide refugia (pools)
vegetation r o F I Sand bottom
C Multiple snags and logs (including lap trees) r `m F J 5% vertical bank along the marsh
D 5% undercut banks and/or root mats and/or roots 02 F K Little or no habitat
in banks extend to the normal wetted perimeter
F E Little or no habitat
""`"'"""'""`•**`*'"...REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS'•*•-- �'•*" "•
11. Bedform and Substrate -assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
11 a. (- Yes t4 No Is assessment reach in a natural sand -bed stream? (skip for Coastal Plain streams)
11 b. Bedform evaluated. Check the appropriate box(es).
VIA Riffle -run section (evaluate 11c)
F B Pool -glide section (evaluate 11d)
F-I C Natural bedform absent (skip to Metric 12, Aquatic Life)
11 c. In riffles sections, check all that occur below the normal wetted perimeter of the assessment reach - whether or not submerged.
Check at least one box in each row (skip for Size 4 Coastal Plain Streams and Tidal Marsh Streams). Not Present (NP) _
absent, Rare (R) = present but <- 10%, Common (C) _ > 10-40%, Abundant (A) _ > 40-70%, Predominant (P) _ > 70%. Cumulative
percentages should not exceed 100% for each assessment reach.
NP R C A P
Bedrock/saprolite
Boulder (256 - 4096 mm)
Cobble (64 - 256 mm)
Gravel (2 - 64 mm)
Sand (.062 - 2 mm)
Silt/clay (< 0.062 mm)
Detritus
Artificial (rip -rap, concrete, etc.)
11d. C' Yes C' No Are pools filled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)

12. Aquatic Life — assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
12a. t7 Yes C' No Was an in -stream aquatic life assessment performed as described in the User Manual?
If No, select one of the following reasons and skip to Metric 13. f' No Water f' Other:
12b. f' Yes C: No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check
all that apply. If No, skip to Metric 13.
1 >1 Numbers over columns refer to "individuals" for size 1 and 2 streams and "taxa" for size 3 and 4 streams.
F FAduItfrogs
F F Aquatic reptiles
F F Aquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
F F Beetles (including water pennies)
F F_ Caddisfly larvae (Trichoptera [T])
F F Asian clam (Corbicu/a )
F F Crustacean (isopod/amphipod/crayfish/shrimp)
F F Damselfly and dragonfly larvae
F F Dipterans (true flies)
F F Mayfly larvae (Ephemeroptera [E])
F F Megaloptera (alderfly, fishfly, dobsonfly larvae)
F F Midges/mosquito larvae
F F Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea)
F F Mussels/Clams (not Corbicu/a )
F F Other fish
F F Salamanders/tadpoles
F F Snails
F F Stonefly larvae (Plecoptera [P])
F F Tipulid larvae
F F Worms/leeches
13. Streamside Area Ground Surface Condition — streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB). Consider storage capacity with regard to both overbank flow and
upland runoff.
LB
RB
A
A
Little or no alteration to water storage capacity over a majority of the streamside area
B
�' B
Moderate alteration to water storage capacity over a majority of the streamside area
C' C
C' C
Severe alteration to water storage capacity over a majority of the streamside area (examples include: ditches, fill,
soil, compaction, livestock disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area Water Storage — streamside area metric (skip for Size 1 streams, Tidal Marsh Streams, and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
A A Majority of streamside area with depressions able to pond water z 6 inches deep
B �' B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
C' C C' C Majority of streamside area with depressions able to pond water < 3 inches deep
15. Wetland Presence — streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB). Do not consider wetlands outside of the streamside area or within the
normal wetted perimeter of assessment reach.
LB RB
Y Y Are wetlands present in the streamside area?
N N
16. Baseflow Contributors — assessment reach metric (skip for size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
F A Streams and/or springs (jurisdictional discharges)
F B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
F C Obstruction that passes some flow during low -flow periods within assessment area (beaver dam, bottom -release dam)
F D Evidence of bank seepage or sweating (iron oxidizing bacteria in water indicates seepage)
F E Stream bed or bank soil reduced (dig through deposited sediment if present)
F F None of the above
17. Baseflow Detractors — assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
F A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
F B Obstruction not passing flow during low flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
F C Urban stream (>_ 24% impervious surface for watershed)
F D Evidence that the stream -side area has been modified resulting in accelerated drainage into the assessment reach
F E Assessment reach relocated to valley edge
F F None of the above

18. Shading - assessment reach metric (skip for Tidal Marsh Streams)
Consider aspect. Consider "leaf -on" condition.
A Stream shading is appropriate for stream category (may include gaps associated with natural processes)
(: B Degraded (example: scattered trees)
C Stream shading is gone or largely absent
19. Buffer Width - streamside area metric (skip for Tidal Marsh Streams)
Consider "vegetated buffer" and "wooded buffer" separately for left bank (LB) and right bank (RB) starting at the top
of bank out to the first break.
Vegetated Wooded
LB RB LB RB
A A A A z 100-feet wide or extends to the edge of the watershed
B r B �' B r B From 50 to < 100-feet wide
C C C C From 30 to < 50-feet wide
r D �' D r D �' D From 10 to < 30-feet wide
E E E E < 10-feet wide or no trees
20. Buffer Structure - streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Vegetated" Buffer Width).
LB
RB
(' A
(' A
Mature forest
(: B
(: B
Non -mature woody vegetation or modified vegetation structure
C
C
Herbaceous vegetation with or without a strip of trees < 10 feet wide
D
D
Maintained shrubs
E
�' E
Little or no vegetation
21. Buffer Stressors - streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB). Indicate if listed stressor abuts stream (Abuts), does not abut but
is within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If none of the following stressors occurs on either bank, check here and skip to Metric 22:
Abuts < 30 feet 30-50 feet
LB RB LB RB LB RB
A A A A A A Row crops
B B B B B B Maintained turf
C �' C �' C �' C �' C �' C Pasture (no livestock)/commercial horticulture
D D D D D D Pasture (active livestock use)
22. Stem Density - streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Wooded" Buffer Width).
LB RB
(' A (' A Medium to high stem density
(: B (: B Low stem density
(' C (' C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer- streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10-feet wide.
LB RB
(' A (' A The total length of buffer breaks is < 25 percent.
G B G B The total length of buffer breaks is between 25 and 50 percent.
(^ C (^ C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition - First 100 feet of streamside area metric (skip for Tidal Marsh Streams)
Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contributes
to assessment reach habitat.
LB RB
(' A (' A Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native
species, with non-native invasive species absent or sparse.
G B G B Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear -cutting or clearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
(^ C (^ C Vegetation is severely disturbed in terms of species diversity or proportions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non -characteristic species or communities inappropriately composed of a single species or no vegetation.
25. Conductivity - assessment reach metric (skip for all Coastal Plain streams)
25a. (' Yes G No Was a conductivity measurement recorded?
If No, select one of the following reasons. (^ No Water (' Other:
251b. Check the box corresponding to the conductivity measurement (units of microsiemens per centimeter).
(' A <46 (' B 46 to < 67 (' C 67 to < 79 (' D 79 to < 230 (' E >- 230
Notes/Sketch:

NC WAM WETLAND ASSESSMENT FORM
Accompanies User Manual Version 5
USACE AID#: NCDWR #:
Project Name U-5907 Potts -Sloan Ext Date of Evaluation August 27, 2015
Applicant/Owner Name NCDOT Wetland Site Name WA
Wetland Type Headwater Forest Assessor Name/Organization C. Tinklenberg/Kimley-Horn
Level III Ecoregion Piedmont Nearest Named Water Body Lake Norman
River Basin Catawba USGS 8-Digit Catalogue Unit 03050101
County Mecklenburg NCDWR Region Mooresville
C' Yes C: No Precipitation within 48 hrs? Latitude/Longitude (deci-degrees) 35.499661,-80.851739
Evidence of stressors affecting the assessment area (may not be within the assessment area)
Please circle and/or make note on last page if evidence of stressors is apparent. Consider departure from reference, if
appropriate, in recent past (for instance, approximately within 10 years). Noteworthy stressors include, but are not limited
to the following.
• Hydrological modifications (examples: ditches, dams, beaver dams, dikes, berms, ponds, etc.)
• Surface and sub -surface discharges into the wetland (examples: discharges containing obvious pollutants, presence of nearby
septic tanks, underground storage tanks (USTs), hog lagoons, etc.)
• Signs of vegetation stress (examples: vegetation mortality, insect damage, disease, storm damage, salt intrusion, etc.)
• Habitat/plant community alteration (examples: mowing, clear -cutting, exotics, etc.)
Is the assessment area intensively managed? C' Yes C@ No
Regulatory Considerations - Were regulatory considerations evaluated? Ca Yes C' No If Yes, check all that apply to the assessment area.
F Anadromous fish
F Federally protected species or State endangered or threatened species
F_ NCDWR riparian buffer rule in effect
F Abuts a Primary Nursery Area (PNA)
F Publicly owned property
F N.C. Division of Coastal Management Area of Environmental Concern (AEC) (including buffer)
F Abuts a stream with a NCDWQ classification of SA or supplemental classifications of HQW, ORW, or Trout
F Designated NCNHP reference community
F Abuts a 303(d)-listed stream or a tributary to a 303(d)-listed stream
What type of natural stream is associated with the wetland, if any? (check all that apply)
f Blackwater
f: Brownwater
F Tidal (if tidal, check one of the following boxes) C' Lunar f Wind C' Both
Is the assessment area on a coastal island? C' Yes Ca No
Is the assessment area's surface water storage capacity or duration substantially altered by beaver? C' Yes C: No
Does the assessment area experience overbank flooding during normal rainfall conditions? C' Yes Ca No
1. Ground Surface Condition/Vegetation Condition — assessment area condition metric
Check a box in each column. Consider alteration to the ground surface (GS) in the assessment area and vegetation structure
(VS) in the assessment area. Compare to reference wetland if applicable (see User Manual). If a reference is not applicable,
then rate the assessment area based on evidence of an effect.
GS VS
fa— A Ca A Not severely altered
f B C' B Severely altered over a majority of the assessment area (ground surface alteration examples: vehicle tracks, excessive
sedimentation, fire -plow lanes, skidder tracks, bedding, fill, soil compaction, obvious pollutants) (vegetation structure
alteration examples: mechanical disturbance, herbicides, salt intrusion [where appropriate], exotic species, grazing,
less diversity [if appropriate], hydrologic alteration)
2. Surface and Sub -Surface Storage Capacity and Duration — assessment area condition metric
Check a box in each column. Consider surface storage capacity and duration (Surf) and sub -surface storage capacity and
duration (Sub). Consider both increase and decrease in hydrology. A ditch 5 1 foot deep is considered to affect surface water only,
while a ditch > 1 foot deep is expected to affect both surface and sub -surface water. Consider tidal flooding regime, if applicable.
Surf Sub
f A C' A Water storage capacity and duration are not altered.
C� B f: B Water storage capacity or duration are altered, but not substantially (typically, not sufficient to change vegetation).
f C C' C Water storage capacity or duration are substantially altered (typically, alteration sufficient to result in vegetation
change) (examples: draining, flooding, soil compaction, filling, excessive sedimentation, underground utility lines).
3. Water Storage/Surface Relief — assessment area/wetland type condition metric (skip for all marshes)
Check a box in each column for each group below. Select the appropriate storage for the assessment area (AA) and the wetland
type (WT).
AA WT
3a. f A C' A Majority of wetland with depressions able to pond water > 1 foot deep
f B C' B Majority of wetland with depressions able to pond water 6 inches to 1 foot deep
f� C C Majority of wetland with depressions able to pond water 3 to 6 inches deep
f D C' D Depressions able to pond water < 3 inches deep

3b. f A Evidence that maximum depth of inundation is greater than 2 feet
f B Evidence that maximum depth of inundation is between 1 and 2 feet
G C Evidence that maximum depth of inundation is less than 1 foot

4. Soil Texture/Structure — assessment area condition metric (skip for all marshes)
Check a box from each of the three soil property groups below. Dig soil profile in the dominant assessment area landscape
feature. Make soil observations within the 12 inches. Use most recent National Technical Committee for Hydric Soils guidance for
regional indicators.
4a. (_ A Sandy soil
G B Loamy or clayey soils exhibiting redoximorphic features (concentrations, depletions, or rhizospheres)
C Loamy or clayey soils not exhibiting redoximorphic features
D Loamy or clayey gleyed soil
E Histosol or histic epipedon
4b. A Soil ribbon < 1 inch
B Soil ribbon >— 1 inch
4c. G A No peat or muck presence
(' B A peat or muck presence
5. Discharge into Wetland — opportunity metric
Check a box in each column. Consider surface pollutants or discharges (Surf) and sub -surface pollutants or discharges (Sub).
Examples of sub -surface discharges include presence of nearby septic tank, underground storage tank (UST), etc.
Surf Sub
(: A C: A Little or no evidence of pollutants or discharges entering the assessment area
( B C' B Noticeable evidence of pollutants or discharges entering the wetland and stressing, but not overwhelming the
treatment capacity of the assessment area
f C C' C Noticeable evidence of pollutants or discharges (pathogen, particulate, or soluble) entering the assessment area and
potentially overwhelming the treatment capacity of the wetland (water discoloration, dead vegetation, excessive
sedimentation, odor)
6. Land Use — opportunity metric (skip for non -riparian wetlands)
Check all that apply (at least one box in each column). Evaluation involves a GIS effort with field adjustment. Consider sources
draining to assessment area within entire upstream watershed (WS), within 5 miles and within the watershed draining to the
assessment area (5M), and within 2 miles and within the watershed draining to the assessment area (2M). Effective riparian buffers
are considered to be 50 feet wide in the Coastal Plain and Piedmont ecoregions and 30 feet wide in the Blue Ridge Mountains ecoregion.
WS 5M 2M
(✓ A (✓ A (✓ A z 10% impervious surfaces
F B F B F B Confined animal operations (or other local, concentrated source of pollutants)
F- C F- C F C z 20% coverage of pasture
F D F D F— D z 20% coverage of agricultural land (regularly plowed land)
F E F E F E z 20% coverage of maintained grass/herb
F F F F F F z 20% coverage of clear-cut land
F G F G F G Little or no opportunity to improve water quality. Lack of opportunity may result from little or no disturbance in
the watershed or hydrologic alterations that prevent dainage and/or overbank flow from affectio the
assessment area.
Wetland Acting as Vegetated Buffer — assessment area/wetland complex condition metric (skip for non -riparian wetlands)
7a. Is assessment area within 50 feet of a tributary or other open water?
(: Yes ( No If Yes, continue to 7b. If No, skip to Metric 8.
7b. How much of the first 50 feet from the bank is weltand? (Wetland buffer need only be present on one side of the water body. Make
buffer judgment based on the average width of wetland. Record a note if a portion of the buffer has been removed or disturbed.)
( A >_ 50 feet
( B From 30 to < 50 feet
(: C From 15 to < 30 feet
( D From 5 to < 15 feet
f E < 5 feet or buffer bypassed by ditches
7c. Tributary width. If the tributary is anastomosed, combine widths of channels/braids for a total width.
(: < 15-feet wide (> 15-feet wide f Other open water (no tributary present)
7d. Do roots of assessment area vegetation extend into the bank of the tributary/open water?
(: Yes f No
7e. Is tributary or other open water sheltered or exposed?
(: Sheltered — adjacent open water with width < 2500 feet and no regular boat traffic.
(Exposed — adjacent open water with width z 2500 feet or regular boat traffic.
8. Wetland Width at the Assessment Area — wetland type/wetland complex condition metric (evaluate WT for all marshes
and Estuarine Woody Wetland only; evaluate WC for Bottomland Hardwood Forest, Headwater Forest, and Riverine Swamp
Forest only)
Check a box in each column. Select the average width for the wetland type at the assessment area (WT) and the wetland complex at the
assessment area (WC). See User Manual for WT and WC boundaries.
WT WC
(' A
(' A
z 100 feet
(� B
(' B
From 80 to < 100 feet
(' C
C' C
From 50 to < 80 feet
(' D
(' D
From 40 to < 50 feet
( E
(' E
From 30 to < 40 feet
G F
C: F
From 15 to < 30 feet
(' G
C' G
From 5 to < 15 feet
( H
(' H
< 5 feet

9. Inundation Duration — assessment area condition metric (skip for non -riparian wetlands)
Answer for assessment area dominant landform.
f A Evidence of short -duration inundation (< 7 consecutive days)
t: B Evidence of saturation, without evidence of inundation
f C Evidence of long -duration inundation or very long -duration inundation (7 to 30 consecutive days or more)
10. Indicators of Deposition — assessment area condition metric (skip for non -riparian wetlands and all marshes)
Consider recent deposition only (no plant growth since deposition).
f A Sediment deposition is not excessive, but at approximately natural levels.
f: B Sediment deposition is excessive, but not overwhelming the wetland.
f C Sediment deposition is excessive and is overwhelming the wetland.
11. Wetland Size — wetland type/wetland complex condition metric
Check a box in each column. Involves a GIS effort with field adjustment. This metric evaluates three aspects of the wetland area: the
size of the wetland type (WT), the size of the wetland complex (WC), and the size of the forested wetland (FW) (if applicable, see User
Manual). See the User Manual for boundaries of these evaluation areas. If assessment area is clear-cut, select "K" for the FW column.
WT WC FW (if applicable)
f A C' A f A >_ 500 acres
f B C' B f B From 100 to < 500 acres
f C C' C f C From 50 to < 100 acres
f D C' D f D From 25 to < 50 acres
f E C' E f E From 10 to < 25 acres
f F C' F f F From 5 to < 10 acres
f G C' G f G From 1 to < 5 acres
f H C' H f H From 0.5 to < 1 acre
f I C' I f' I From 0.1 to < 0.5 acre
t: J t: J t: J From 0.01 to < 0.1 acre
f K (— K f K < 0.01 acre or assessment area is clear-cut
12. Wetland Intactness — wetland type condition metric (evaluate for Pocosins only)
f A Pocosin is the full extent (>: 90%) of its natural landscape size.
f B Pocosin is < 90% of the full extent of its natural landscape size.
13. Connectivity to Other Natural Areas — landscape condition metric
13a. Check appropriate box(es) (a box may be checked in each column). Involves a GIS effort with field adjustment. This
evaluates whether the wetland is well connected (Well) and/or loosely connected (Loosely) to the landscape patch, the contiguous
metric naturally vegetated area and open water (if appropriate). Boundaries are formed by four -lane roads, regularly maintained utility
line corridors the width of a four -lane road or wider, urban landscapes, fields (pasture open and agriculture), or water > 300 feet wide.
Well Loosely
f A C' A >_ 500 acres
f B C' B From 100 to < 500 acres
f C C' C From 50 to < 100 acres
f D C' D From 10 to < 50 acres
f E t: E < 10 acres
t: F (— F Wetland type has a poor or no connection to other natural habitats
13b. Evaluate for marshes only.
f Yes (— No Wetland type has a surface hydrology connection to open waters/stream or tidal wetlands.
14. Edge Effect — wetland type condition metric (skip for all marshes and Estuarine Woody Wetland)
May involve a GIS effort with field adjustment. Estimate distance from wetland type boundary to artificial edges. Artificial edges include
non -forested areas >_ 40 feet wide such as fields, development, roads, regularly maintained utility line corridors and clear -cuts. Consider
the eight main points of the compass. Artificial edge occurs within 150 feet in how many directiions? If the assessment area is clear-cut,
select option "C."
f A 0
f B 1 to 4
f: C 5 to 8
15. Vegetative Composition — assessment area condition metric (skip for all marshes and Pine Flat)
f A Vegetation is close to reference condition in species present and their proportions. Lower strata composed of appropriate
species, with exotic plants absent or sparse within the assessment area.
f: B Vegetation is different from reference condition in species diversity or proportions, but still largely composed of native species
characteristic of the wetland type. This may include communities of weedy native species that develop after clearcutting or
clearing. It also includes communities with exotics present, but not dominant, over a large portion of the expected strata.
f C Vegetation severely altered from reference in composition, or expected species are unnaturally absent (planted stands of non -
characteristic species or at least one stratum inappropriately composed of a single species), or exotic species are dominant in
at least one stratum.
16. Vegetative Diversity — assessment area condition metric (evaluate for Non -tidal Freshwater Marsh only)
f A Vegetation diversity is high and is composed primarily of native species (<10% cover of exotics).
t: B Vegetation diversity is low or has > 10% to 50% cover of exotics.
f C Vegetation is dominated by exotic species (>50% cover of exotics).

17. Vegetative Structure — assessment area/wetland type condition metric
17a. Is vegetation present?
C: Yes t— No If Yes, continue to 17b. If No, skip to Metric 18.
17b. Evaluate percent coverage of assessment area vegetation for all marshes only. Skip to 17c for non -marsh wetlands.
f A >_ 25% coverage of vegetation
i B < 25% coverage of vegetation
17c. Check a box in each column for each stratum. Evaluate this portion of the metric for non -marsh wetlands. Consider structure
in airspace above the assessment area (AA) and the wetland type (WT) separately.
AA
WT
n (— A
C A
Canopy closed, or nearly closed, with natural gaps associated with natural processes
°c (: B
(:B
Canopy present, but opened more than natural gaps
U C
C C
Canopy sparse or absent
os ` A
A
Dense mid-story/sapling layer
to B
(: B
Moderate density mid-story/sapling layer
t— C
(` C
Mid-story/sapling layer sparse or absent
C A
C A
Dense shrub layer
C- B
.— B
Moderate density shrub layer
cO (: C (: C Shrub layer sparse or absent
C A t A Dense herb layer
(— B f B Moderate density herb layer
( C (a- C Herb layer sparse or absent
18. Snags — wetland type condition metric (skip for all marshes)
(— A Large snags (more than one) are visible (> 12-inches DBH, or large relative to species present and landscape stability).
(: B Not A
19. Diameter Class Distribution — wetland type condition metric (skip for all marshes)
C-, A Majority of canopy trees have stems > 6 inches in diameter at breast height (DBH); many large trees (> 12 inches DBH) are
present.
C' B Majority of canopy trees have stems between 6 and 12 inches DBH, few are > 12-inch DBH.
Ce C Majority of canopy trees are < 6 inches DBH or no trees.
20. Large Woody Debris — wetland type condition metric (skip for all marshes)
Include both natural debris and man -placed natural debris.
f A Large logs (more than one) are visible (> 12 inches in diameter, or large relative to species present and landscape stability).
t—o B Not A
21. Vegetation/Open Water Dispersion — wetland type/open water condition metric (evaluate for Non -Tidal Freshwater
Marsh only)
Select the figure that best describes the amount of interspersion between vegetation and open water in the growing season. Patterned
areas indicate vegetated areas, while solid white areas indicate open water.
A rB C'C r'D
r
22. Hydrologic Connectivity— assessment area condition metric (evaluate for riparian wetlands and Salt/Brackish Marsh only)
Examples of activities that may severely alter hydrologic connectivity include intensive ditching, fill, sedimentation, channelization,
diversion, man-made berms, beaver dams, and stream incision. Documentation required if evaluated as B, C, or D.
C` A Overbank and overland flow are not severely altered in the assessment area.
i B Overbank flow is severely altered in the assessment area.
C� C Overland flow is severely altered in the assessment area.
f D Both overbank and overland flow are severely altered in the assessment area.
Notes

Wetland Site Name
Wetland Type
NC WAM Wetland Rating Sheet
Accompanies User Manual Version 5.0
rm
Headwater Forest
Date August 27, 2015
Assessor Name/Organization Tin klenberg/Ki mley-Hor
Notes on Field Assessment Form (Y/N) NO
Presence of regulatory considerations (Y/N) NO
Wetland is intensively managed (Y/N) NO
Assessment area is located within 50 feet of a natural tributary or other open water (Y/N) YES
Assessment area is substantially altered by beaver (Y/N) NO
Assessment area experiences overbank flooding during normal rainfall conditions (Y/N) NO
Assessment area is on a coastal island (Y/N) NO
Sub -function Rating Summary
Function
Sub -function
Metrics
Rating
Hydrology
Surface Storage and Retention
Condition
MEDIUM
Sub -Surface Storage and Retention
Condition
HIGH
Water Quality
Pathogen Change
Condition
MEDIUM
Condition/Opportunity
MEDIUM
Opportunity Presence? (Y/N)
NO
Particulate Change
Condition
LOW
Condition/Opportunity
NA
Opportunity Presence? (Y/N)
NA
Soluble Change
Condition
LOW
Condition/Opportunity
LOW
Opportunity Presence? (Y/N)
NO
Physical Change
Condition
MEDIUM
Condition/Opportunity
MEDIUM
Opportunity Presence? (Y/N)
NO
Pollution Change
Condition
NA
Condition/Opportunity
NA
Opportunity Presence? (Y/N)
NA
Habitat
Physical Structure
Condition
LOW
Landscape Patch Structure
Condition
LOW
Vegetation Composition
Condition
MEDIUM
Function Rating Summary
Function
Metrics/Notes
Rating
Hydrology
Condition
HIGH
Water Quality
Condition
LOW
Condition/Opportunity
LOW
Opportunity Presence? (Y/N)
NO
Habitat
Condition
LOW
Overall Wetland Rating LOW

MINIMUM CRITERIA DETERMINATION
CHECKLIST

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
MINIMUM CRITERIA DETERMINATION CHECKLIST
TIP Project No.: U-5907
State Project No.: 46452.1.1
Project Location: Extension of Potts Street north to connect with Sloan Street and
construction of a roundabout at the intersection of Sloan Street and Griffith Street in the
Town of Davidson, Mecklenburg County.
Project Description: The purpose of this project is to add an alternative route between
N.C. 115 and Griffith Street for multiple modes of transportation. The project includes
three elements (Figures 2A — 2E):
• Extension of Potts Street to Sloan Street, including an 8-foot sidewalk.
• Replace and fill in missing segments of 5-foot sidewalk along existing Potts
Street.
• Construction of a roundabout at the intersection of Sloan Street and Griffith
Street.
Anticipated Permit or Consultation Requirements: A Section 404, Nationwide Permit
(NWP) 23, will likely be required to authorize project construction of the proposed
project and crossing of streams SA and SB and wetland WA (Figure 2C and 2F). As
such, a Section 401 Water Quality Certification from the North Carolina Department of
Water Resources would also be required for this portion of the project.
NCDOT will continue to coordinate with the State Historic Preservation Officer (SHPO)
and consulting parties to complete a Memorandum of Agreement (MOA) for adverse
effects on the National Register -listed Davidson Historic District.
Special Project Information:
Water Resources
Water resources in the project study area are part of the Catawba River Basin. One
perennial stream (SA), one intermittent stream (SB), and one wetland (WA) were
identified in the study area, and referenced in the Natural Resources Technical Report
(NRTR) dated March 2017. Approximately 235 linear feet of impacts to stream SA and
10 linear feet of impacts to stream SB (for a total of 245 feet) are anticipated. Less than
0.1 acres of impacts to wetland WA are anticipated.
Threatened and Endangered Species
There are six threatened and endangered, federally protected species listed for
Mecklenburg County by the U.S. Fish and Wildlife (USFWS) (updated June 27, 2018):
northern long-eared bat (NLEB), Carolina heelsplitter, Michaux's sumac, Schweinitz's
sunflower, smooth coneflower, and rusty -patched bumble bee. The project has been
determined to have "No Effect" on the Michaux's sumac, Schweinitz's sunflower, and
the smooth coneflower as listed in the NRTR. In a memo dated July 2018, the project was
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determined to have "No Effect" on the Carolina heelsplitter and included a conclusion of
"May Affect, Not Likely to Adversely Affect" on the NLEB. A biological conclusion is
not required for the rusty patched bumble bee (RPBB); the USFWS does not, and will
not, require surveys for RPBB in North Carolina because USFWS assumes the state is
unoccupied by RPBB.
According to the NRTR, one body of water (Lake Norman) was identified within a 1.13-
mile radius of the project limits as being large enough and sufficiently open to be
considered a potential feeding source and foraging habitat for the bald eagle. Based on
the NCNHP database, updated October 2016, and a field investigation conducted on
October 25, 2016, the project will have "No Effect" on the bald eagle due to no known
occurrences and the lack of observed individuals or nests.
The USFWS lists one federal Endangered Species Act candidate species, the Georgia
aster, for Mecklenburg County (updated June 27, 2018). A review of the NCNHP
records, updated October 2016, indicates no known occurrence of the Georgia aster
within 1.0 mile of the study area.
Cultural Resources
A "No Archaeological Survey Required Form" was completed by NCDOT on April 20,
2017. A "Historic Architecture and Landscapes Effects Assessment Required Form" was
completed by NCDOT on April 4, 2017. The U-5907 Area of Potential Effect intersects
with the Davidson Historic District, which is listed in the National Register of Historic
Places (NRHP).
On July 2, 2018, NCDOT and the State Historic Preservation Officer (SHPO) determined
that the proposed extension of Potts Street and the improvement of sidewalk along the
existing Potts Street through the Davidson Historic District would have a "Conditional
No Adverse Effect." The project team committed to use:
• Board protection for trees
• Orange fencing for vegetation during construction
• Asphalt pavement over tree roots instead of concrete
• 5-foot sidewalk from the beginning of the project past the north side of the
existing cul-de-sac
NCDOT and SHPO determined that the proposed roundabout at the Sloan Street, Griffith
Street, and Beaty Street intersection would have an "Adverse Effect" due to temporary
and permanent easements that are anticipated to impact the property at 335 Sloan Street,
which contains a contributing structure to the Davidson Historic District. NCDOT will
continue to coordinate with the State Historic Preservation Office (SHPO) and consulting
parties to complete a Memorandum of Agreement (MOA).
Public Parks
Roosevelt Wilson Park, a Section 4(f) resource owned by the Town of Davidson, is
located in the southwest quadrant of the Sloan Street and Griffith Street intersection, just
behind the row of residences along Sloan Street. Based on current designs, additional
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right-of-way and/or easements will be required from this resource to extend the proposed
8-foot multi -use trail to meet the existing trail. A letter from the Town of Davidson
Project & Public Works Director, dated July 13, 2018, stated that the proposed
transportation use of the resource will not adversely affect the activities, features, or
attributes of the resource. This determination will be used as basis for a de minimis
impact conclusion.
The Davidson Community Garden is located within the project study area but will not be
impacted by the project.
Multimodal Facilities
The Lake Norman Bike Route runs along Potts Street and currently uses Jetton Street and
Gamble Street to reach Sloan Street. The proposed project is anticipated to provide an
easier continuation of the bike route to Sloan Street by removing two turns.
Potential Hazardous Materials
According to a letter from the NCDOT Geotechnical Engineering Unit dated April 6,
2017, two hazardous materials sites were identified within the project study area:
• Bellsouth-Davidson property located at 302 Potts Street, containing an
underground storage tank
• Town of Davidson property located along the northeastern side of W. Walnut
Street between Potts Street and Gamble Street (no address is assigned to these two
parcels), containing an aboveground storage tank
A detailed Phase I study of the preferred alternative was recommended to field verify the
hazardous waste sites and identify unknown sites. The Phase I study will be completed
prior to right-of-way acquisition.
At a public meeting held in September 2016 to discuss plans for the development the
Davidson Depot, located at 301 Depot Street within the Town of Davidson, citizens
raised concerns about asbestos contamination on their properties. As a result, the
Environmental Protection Agency (EPA) conducted a site visit in November 2016 within
the neighborhoods along Sloan Street, Depot Street, Eden Street, and the northern end of
Potts Street. Material contaminated with asbestos migrating from a former mill property
located near Eden Street and Sloan Street was observed during the site visit. The EPA
tested approximately 130 locations in proximity to the old mill site, within the Town of
Davidson. Of the locations sampled, 25 samples were above detection limits, 30 samples
had trace findings of asbestos, and asbestos was not found in the remaining 80 samples.
Properties where asbestos is present will be excavated and new soil placed on top with a
membrane separating the two layers of soil. Public meetings were also held on December
15, 2016, April 4, 2017, and October 3, 2017 to present the mitigation plan to concerned
citizens. NCDOT will have asbestos monitors present during construction.
Public Outreach
A joint public meeting was held on October 5, 2017 for Project U-5907 and nearby
Project U-5873 (intersection improvements at Potts Street and N.C. 115). The public was
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DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
presented three alternatives for the Potts Street extension. Questions and comments on
the alternatives were gathered. A total of 24 comments were received within the two -
week comment period following the public meeting in reference to U-5907, and 23
comments and two petitions were received during that same period in reference to both
U-5907 and U-5873. The currently recommended alternative was selected based on
anticipated impacts, input from the Town and public, and costs.
Concerns presented by the public regarding impacts to historic resources and existing
trees along Potts Street were addressed by reducing the previously proposed 10-foot-wide
multi -use trail along the entire project to the currently proposed 8-foot wide multi -use
trail along the extension of Potts Street and Sloan Street, and a 5-foot wide sidewalk
along the existing Potts Street.
10/04/18 4 of 7

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
PART A: MINIMUM CRITERIA
Item I to be completed by the Engineer. YES NO
1. Is the proposed project listed as a type and class of activity allowed under ® ❑
the Minimum Criteria Rule in which environmental documentation is not
required?
If the answer to number 1 is "no", then the project does not qualify as a
minimum criteria project. A state environmental assessment is required.
If yes, under which category? #15
If either category #8, #12(i) or #15 is used complete Part D of this checklist.
PART B: MINIMUM CRITERIA EXCEPTIONS
Items 2 — 4 to be completed by the Engineer.
YES
NO
2. Could the proposed activity cause significant changes in land use
concentrations that would be expected to create adverse air quality
impacts?
3. Will the proposed activity have secondary impacts or cumulative
impacts that may result in a significant adverse impact -to human health
or the environment?
4. Is the proposed activity of such an unusual nature or does the proposed
activity have such widespread implications, that an uncommon concern
for its environmental effects has been expressed to the Department?
Item 5-8 to be completed by Division Environmental Officer. 1
5. Does the proposed activity have a significant adverse effect on wetlands; ❑
surface waters such as rivers, streams, and estuaries; parklands; prime or
unique agricultural lands; or areas of recognized scenic, recreational,
archaeological, or historical value?
6. Will the proposed activity endanger the existence of a species on the ❑
Department of Interior's threatened and endangered species list?
7. Could the proposed activity cause significant changes in land use ❑
concentrations that would be expected to create adverse water quality or
ground water impacts?
10/04/18 5 of 7

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
YES NO
8. Is the proposed activity expected to have a significant adverse effect on ❑
long-term recreational benefits or shellfish, finfish, wildlife, or their
natural habitats
PART C: COMPLIANCE WITH STATE AND FEDERAL REGULATIONS
Items 9-12 to be completed by Division Environmental Officer. YES NO
9.
Is a federally protected threatened or endangered species, or its
❑
habitat, likely to be impacted by the proposed action?
10.
Does the action require the placement of temporary or permanent
® ❑
fill in waters of the United States?
11.
Does the project require the placement of a significant amount of
❑ ❑
fill in high quality or relatively rare wetland ecosystems, such as
mountain bogs or pine savannahs?
12.
Is the proposed action located in an Area of Environmental
❑
Concern, as defined in the coastal Area Management Act?
Items
13 —15 to be completed by the Engineer. UL
13.
Does the project require stream relocation or channel changes?
® ❑
Cultural Resources
14.
Will the project have an "effect" on a property or site listed on the
❑ ❑
National Register of Historic Places?
15.
Will the proposed action require acquisition of additional right of
® ❑
way from publicly owned parkland or recreational areas?
10/04/18 6 of 7

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
PART D:( To be completed when either category #8, 120) or #15 of the rules are
used.
Items 16- 22 to be completed by Division Environmental Officer.
16. Project length:
17. Right of Way width:
18. Project completion date:
19. Total acres of newly disturbed ground
surface:
20. Total acres of wetland impacts:
21. Total linear feet of stream impacts:
22. Project purpose:
Approx. 4,000 if
Varies
FY 2020
1.9 acres
Less than 0.1 acres
2451f
To add an alternative
route between N.C. 115
and Griffith Street for
multiple transportation
modes.
DocuSigned by:
Prepared by: 167Q.91nnFSAA40C__
Teresa Gresham, PE, Consultant Project Manager
Kimley-Horn and Associates, Inc.
DocuSigned by:
Reviewed by:
AQ7F75(:f:n,,RdQR
Sean Epperson, PE, Division Project Team Lead
Highway Division 10
North Carolina Departmt of Transportation
Th pson, 1 WS, LSS, Division Environmental Officer
:� Division 10
Carolina Department of Transportation
10/11/2018
Date:
10/11/2018
Date:
Date: 10-11-18
10/04/18 7 of 7

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
Project Commitments
Mecklenburg County
Extension of Potts Street north to connect with Sloan Street and construction of a
roundabout at the intersection of Sloan Street and Griffith Street
WBS No. 46452.1.1
TIP No. U-5907
NCDOT Historic Architecture
A Memorandum of Agreement (MOA) will be approved prior to right-of-way purchase of the
properties adjacent to the proposed roundabout. If an MOA is not approved by the time right-of-
way would need to be purchased, the roundabout will be removed from Project U-5907.
The project team committed to use the following along the proposed extension of Potts Street
and the improvement of sidewalk along the existing Potts Street through the Davidson Historic
District:
• Board protection for trees
• Orange fencing for vegetation during construction
• Asphalt pavement over tree roots instead of concrete
• 5-foot sidewalk from the beginning of the project past the north side of the existing cul-
de-sac
NCDOT GeoEnvironmental
A Phase I GeoEnvironmental study will be completed by NCDOT prior to right-of-way
acquisition.
NCDOT Division Construction
NCDOT will have asbestos monitors present during construction of the project.

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er °4th
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Figure 1: Vicinity Map
NCDOT Project No. U-5907
Lakes and Ponds Town of Cornelius
Extend Potts Street to Sloan Street
Streams Mecklenburg County
and Construct Roundabout
at Sloan Street and Griffith Street
Iredell County
Davidson, Mecklenburg County

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Park Property
' Figures 2A - 2E Extents
+ Railroad
G odrum
Figure 2: Design Map
NCDOT Project No. U-5907
Extend Potts Street to Sloan Street
and Construct Roundabout
at Sloan Street and Griffith Street
Davidson, Mecklenburg County

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
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7� l Lake Norman Bike Route
Railroad
--- Proposed Slope Stakes
Proposed Sidewalk
o� Kanry c Figure 2A: Design Map
NCDOT Project No. U-5907
Feet Extend Potts Street to Sloan Street
b s 0 100 200 and Construct Roundabout
at Sloan Street and Griffith Street
"r of ,�*` Davidson, Mecklenburg County

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
SeeFigure 2C
See Figure 2B<
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J`
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. i94r`"fie Cdtd�
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0 100 200
0 U-5907 Study Area
0 National Register District
Lake Norman Bike Route
+ Railroad
---- Proposed Slope Stakes
Proposed Sidewalk
Underground Storage Tanks (UST)
Figure 2113: Design Map
NCDOT Project No. U-5907
Extend Potts Street to Sloan Street
and Construct Roundabout
at Sloan Street and Griffith Street
Davidson, Mecklenburg County

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
W-VA
SA 1.
See Figure 2D
See'Figure 2C
Eden St
i
Davidson
Historic
' ''a� •• ; District
SI; an St ;•� �'
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Delineated Wetland
Local Historic District
® National Register District
Park Property
Lake Norman Bike Route
+ Railroad
---- Proposed Slope Stakes
Proposed Sidewalk
Proposed Edge of Travel
— Delineated Stream
Underground Storage Tanks (UST)
Figure 2C: Design Map
NCDOT Project No. U-5907
Extend Potts Street to Sloan Street
and Construct Roundabout
at Sloan Street and Griffith Street
Davidson, Mecklenburg County

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
Houston St
CREEKSIDEI
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See,Figure 2C
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0 100 200
Eden St
Lingle Hut
(Unity Church
Cabin)
Lingle Hut (Unity
Church Cabin)
0
wN
S
0 U-5907 Study Area
a National Register District
Determined Eligible District
Park Property
Lake Norman Bike Route
---- Proposed Slope Stakes
Proposed Sidewalk
Proposed Edge of Travel
— Delineated Stream
DOE and Landmark
Figure 211): Design Map
NCDOT Project No. U-5907
Extend Potts Street to Sloan Street
and Construct Roundabout
at Sloan Street and Griffith Street
Davidson, Mecklenburg County

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
0
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Park Property
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---- Proposed Slope Stakes
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r Proposed Edge of Travel
— Delineated Stream
%0 ry Figure 2E: Design Map
NCDOT Project No. U-5907
Feet Extend Potts Street to Sloan Street
b 0 100 200 and Construct Roundabout
at Sloan Street and Griffith Street
FHr of*�'� Davidson, Mecklenburg County

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
Project Tracking No. (Internal Use)
17-04-0005
HISTORIC ARCHICTECTURE AND LANDSCAPES
"EFFECTS ASSESSMENT REQUIRED FORM"
This form only pertains to Historic Architecture and Landscapes for this project. It
is not valid for Archaeological Resources. You must consult separately with the
Archaeology Group.
PROJECT INFORMATION
Project No:
U-5907
County:
Mecklenburg
WBS No.:
46452.1.1
Document Type:
MCC
Feel Aid No:
Funding:
® State ❑ Federal
Federal
Permits :
❑ Yes Z No
Permit Type(s):
USACE
Project Description:
Construct a roadway on new location to connect Potts Street with Sloan Street in Davidson.
SUMMARY OF HISTORIC ARCHICTECTURE AND LANDSCAPES REVIEW
Description of review activities, results, and conclusions:
On April 4, 2017 a search of NC HPOWEB GIS Service map reveal that the Area of Potential
Effects intersects with the Davidson Historic District (MK2442). This is a state -funded project
with federal permits. An Effects Meeting will need to be conducted for this project.
SUPPORT DOCUMENTATION
®Map(s) ❑Previous Survey Info. ❑Photos ❑Correspondence ❑Design Plans
FINDING BY NCDOT ARCHITECTURAL HISTORIAN
Historic Architecture and Landscapes -- "EFFECTS ASSESSMENT REQUIRED"
Historic Architecture and Landscapes SURVEY REQUIRED forin for Minor Transportation Projects as Qualified in the 2007 Programmatic Agreement.
Page 1 of 2

iSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
J
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Historic Architecture and Landscapes SURVEY REQUIRED form for Minor Transportation Projects as Qualified in the 2007 Programmatic Agreement.
Page 2 of 2

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Fire Stations
Text Key:
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Schools
Recreational
Davidson Historic District
Post Office
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Lake Norman Bike Route
©
Library
Feet
0 450 900
Figure 2
Environmental Features Map
NCDOT Project No. U-5907
Extend Potts Road
to Sloan Street
Mecklenburg County

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
Project Tracking No. (Internal Use)
17-04-0005b
HISTORIC ARCHICTECTURE AND LANDSCAPES
' ASSESSMENT OF EFFECTS FORM
This -form only pertains to Historic Architecture and Landscapes for this project. It
is not valid for Archaeological Resources. You must consult separately with the
Archaeology Group.
PROJECT INFORMATION
Project No:
U-5907
County:
Mecklenburg
WBS No.:
46452.1.1
Document
Type:
MCC
Fed. Aid No:
Funding:
® State ❑ Federal
Federal
Permits :
® Yes ❑ No
Permit
Tiynot&
USACE
Project Description:
Construct a roundabout at the intersection of Sloan St/Beaty St and Griffith St in Davidson.
CTTX4X4ARv nF UNTORIC ARC14ICTECTURE AND LANDSCAPES REVIEW
Description of review activities, results, and conclusions:
On April 4, 2017 a review of NC HPOWEB GIS online map revealed that this project is within
the National Register listed Davidson Historic District (MK2442). An effect meeting was
scheduled to determine the project's impacts to the historic district.
ARRF.CCMF,NT OF EFFECTS
Property Name: Davidson Historic District Status: NR
Survey Site No.: MK2442 PIN: multiple
Effects Determination
Roundabout Construct a roundabout at Griffith JAd�verseEffect
St/Beaty St/Sloan St
emporary and permanent easements will impact 335 Sloan St, a contributing structure to the
istoric district. The roundabout brings the road closer to the house and impacts access to the
Historic Architecture and Landscapes EFFECTS ASSESSMENTform for Minor Transportation Projects as Qualified in the 2007 Programmatic Agreement.
Page 1 of 2

DocuSign Envelope ID: 06lA45C9-F4D7-43EB-B2C6-FAOFC80AB02A
List of Environmental Commitments:
SUPPORT DOCUMENTATION
®Map(s) ❑Previous Survey Info. ®Photos ❑Correspondence ®Design Plans
FINDING BY NCDOT AND STATE HISTORIC PRESERVATION OFFICE
Historic Architecture and Landscapes —ASSESSMENT OF EFFECTS
1�0
July 2, 2018
NCDOT Architectural Historian Date
State Historic Preservation Office
Representative, Federal Agency
�.a-17
Date
Date
Historic Architecture and Landscapes EFFECTS ASSESSMENT form for Minor Transportation Projects as Qualified in the 2007 Programmatic Agreement.
Page 2 of 2

PERMIT DRAWINGS

I lih�-v�l� North Carolina Department of Transportation
StOi7lriti'at('I Highway Stormwater Program
STORMWATER MANAGEMENT PLAN
(Version 2.07; Released October 2016) FOR NCDOT PROJECTS
WBS Element: 46452.1.1 TIP No.: U-5907 County(ies): Mecklenburg Page 1 of 1
General Project Information
WBS Element:
46452.1.1 TIP Number: U-5907 Project Type: New Location Date: 12/18/2019
NCDOT Contact:
Donald Griffith
Contractor / Designer:
Kimley-Horn & Associates
Address:
716 W. Main Street
Address:
200 South Tryon St, Suite 200
Charlotte, NC 28202
Albemarle, NC 28001
Phone:
[phone]
Phone:
704-319-5683
Email:
dcgriffith(a)ncdot.gov
Email:
iason.lawing(a)kimley-horn.com
City/Town:
Davidson
County(ies):
Mecklenburg
River Basin(s):
Catawba Yadkin -Pee Dee
ICAMA County?
I No
Wetlands within Project Limits?
Yes
Project Description
Project Length (lin. miles or feet):
0.71 Surrounding Land Use: Urban and undeveloped woods
Proposed Project
Existing Site
Project Built -Upon Area (ac.)
4.2 ac.
3.4 ac.
Typical Cross Section Description:
-1-1- Sta 10+00 to 27+62 - Sidewalk and planting strip on LT. -1-1- Sta 27+62 to 33+33 - 2 Lane, C & G,
sidewalk and planting strip on LT. -L1- Sta 33+33 to 39+55 - Sidewalk on LT. -1-1- Sta 41+61 to 42+44, -1-2-
Sta 10+11 to 10+97 - 2 Lane, C & G, sidewalk RT. -1-3- Sta 11+54 to 13+31 - 2 Lane, C & G, sidewalk on LT,
grass shoulder on RT. -Y3- Sta. 12+09 to 21+60 - 3 Lane, bike lane, C & G, sidewalk on LT and RT.
Existing Sloan, Potts, and Beaty streets - 2 Lane, C & G, sidewalk LT. Exisitng Griffith Street, 2 Lane, C &
G with 2 gored lanes alternating as turn lanes.
Annual Avg Daily Traffic (veh/hr/day):
Design/Future: 11100 Year: 2040
Existing: 6,900 Year: 2016
General Project Narrative:
(Description of Minimization of Water
Quality Impacts)
• New roundabout at the intersection of Griffith Street and Beaty Street. New extension of Sloan Street to Potts Street and sidewalk replacement along Potts Street.
• Minimized directly connected impervious surfaces where possible.
Maintaining existing drainage patterns to best extent practical
Avoiding direct discharges where practical
• Use of headwalls on pipes 36" and above to limit stream impacts
Waterbody Information
Surface Water Body 1 : UT to Catawba River Lake Norman
NCDWR Stream Index No.:
11- 75
NCDWR Surface Water Classification for Water Body
Primary Classification:
Water Supply IV WS-IV
Class B
CA
Supplemental Classification:
Other Stream Classification:
None
Impairments:
None
Aquatic T&E Species?
No Comments:
NRTR Stream ID:
SA and SB Buffer Rules in Effect: N/A
Project Includes Bridge Spanning Water Body?
No
Deck Drains Discharge Over Buffer? N/A Dissipator Pads Provided in Buffer? N/A
Deck Drains Discharge Over Water Body?
N/A
(If yes, provide justification in the General Project Narrative) (If yes, describe in the General Project Narrative; if no, justify in the
General Project Narrative)
(If yes, provide justification in the General Project Narrative)

q 168i
END IPRO]E
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NCDOT CONTACT:
DONALD C. GRIFFITH
NCDOT -DIVISION 10
716 W. MAIN STREET
ALBEMARLE, NC 28001
STATE OF NORTH CAROLIN
DIVISION OF HIGHWAYS
z MECKLENBURG COUNTY
WETLAND AND SURFACE WATER IMPACTS PERMIT
LOCATION. POTTS-SLOAN-BEATTY CONNECTOR (NC-115)
TYPE OF WORK: DRAINAGE, GRADING, SIGNALS, & PAVING
'A0
00
s
ti0
P
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BEGIN TIP PROJECT U-5907 O�
-Ll- POT Sta. 10+00.00 ,
DAVIDSON
HISTORIC
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z
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ON OF EL2OC Sta.
SITE 4
SITE 2 y
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END CONSTRUCTION
-Y3- POT Sta. 21 + 60.00
STATE�PRyO.I6CT Q�uRp�IP6R6NCN NO.
NRR
TOTAL
6
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it —590/J
6TATE P.ROl.NO.
A.APR01.N0.
D%CR.IPTION
46452.1.1
WA
PE
46452.2.1
WA
WW & UTIL
46452.2.1
WA
CONST.
BEGIN CONSTRUCTION
-Y3- POT Sta. 11+29.09
-L3-
TY STREET TO DAVIDSON
END TIP PROJECT U-5907
-L3- Sta. 13+31.38
SITE 3
PERMIT DRAWING
SHEET 1 OF 10
n
0
m jj�
w
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0
0
DOCUMENT NOT CONSIDERED FINAL
UNLESS ALL SIGNATURES COMPLETED
GRAPHIC SCALES
DESIGN DATA
PROJECT LENGTH
yle*
PLANS PREPARED FOR Kim>�Horn
H,DRAULICS ENGINEER
ADT 2016 = 6,900 VPD
THE NCDOT BY.•
20 10 0 20 40
ADT 2040 = 11,100 VPD
K = 10%
D = 57%
LENGTH ROADWAY TIP PROJECT U-5907(Ll) = 0.642 MILES
LENGTH ROADWAY TIP PROJECT U-5907(L3) = 0.063 MILES
P.E.
W®SYq
2018 STANDARD SPECIFICATIONS
FRANK MASTERSON, P.E.
PLANS
20 10 0 20 40
T = 15%
V = 30 MPH
SUB REGIONAL TIER
*
TOTAL LENGTH TIP PROJECT U-5907 = 0.705 MILES
RIGHT OF WAY DATE:
52019
PROJECT ENGINEER
ANDREW WEEKS,E.LT.
SIGNATURE.
ROADWAY DESIGN ENGINEER
. ; N CAROB e,
;=OQ:oiE55,:y
PROFILE
PROJECT DESIGN ENGINEER
(HORIZONTAL)
5% TTST 10% DUAL
9
37AL
10 5 0 10 20
LETTING DATE:
0SEAL
`A .�
FUNCTIONAL URBAN
CLASSIFICATION: COLLECTOR
12020
DONALD C. GRIFFITH
0 ......
MgE..."
NCDOT CONTACT
OM� TIP PROJECT MANAGER
PROFILE (VERTICAL)
E.P.E.
SIGNATURE

- ALBERK EMPIRE. LLC
II
�TOWN OF DAVIDSOI•!'
14 -
-I _ _. -' BONNIE D. NEI LL AND
f�11CHAEL A. ENIELL
F3
HOVEY
ENTERPRISES, -
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PROJECT REFERENCE NO.
SHEET NO.
P H
Km l o r n
i
U-5907
7
�IGN SHEET NO.
V1
• y))) • •
ROADWAY
ENGINEER
HYDRAULICS
ENGINEER
10 j0
C7�P
IN15
200 SOUTH TRYON, SUITE 200
CHARLOTTE, N-C- 28202
IN CAgQ�'•,,••
SEAL
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I
i
LEGEND
®
DENOTES FILL IN ® DENOTES IMPACTS IN
WETLAND SURFACE WATER
®
DENOTES TEMPORARY
�
IMPACTS IN SURFACE WATER
O
N
N
HEATHER I ANTONIO BLAINE
"RAND N DAVIS AND IFE.
KELLY ROBIN fLIICH LLE
HOUSTON DAVIS
PERMIT DRAWING
SHEET 2 OF 10
16
GWENDOLYN DIANE
SHERRILL
18
ED Y
17 PA1IERSON
ALEXANDER VY LONG
Wit.
1IAND
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SEE DETAIL A, SHEET 2D-1
21
LATERAL'V' DITCH
SEE DETAIL 2, SHEET 2D-1
THE TOWN OF
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DB 6312 PG 3
PROPOSED SIDEWALK
_ REMOVE AND REPLACE
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DRIVEWAY
RAD11 DIM NSIONS ARE TO THE EDGE
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NOTED
SEE SHEET 14 FOR -L1- PROFILE
SEE SHEET 17 FOR -DRW4- PROFILE

F PROJECT REFERENCE NO. SHEET NO.
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ENGINEER ENGINEER
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DENOTES FILL IN ® DENOTES IMPACTS IN
WETLAND SURFACE WATER
®
DENOTES TEMPORARY
�
IMPACTS IN SURFACE WATER
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N
PERMIT DRAWING
SHEET 3 OF 10
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EST 3 TONS
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SEE DETAIL 4, SHEET 2D-1 ,
21
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SEE DETAIL 2, SHEET 2D-1
THE TOWN OF
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DB 6312 PG 3
PROPOSED SIDEWALK
REMOVE AND REPLACE
- -- -- -- -- EXISTING SIDEWALK AND
DRIVEWAY
RADII DlM NSIONS ARE TO THE EDGE
OF PAVE�ENT UNLESS OTHERWISE
NOTED
SEE SHEET 14 FOR -Ll- PROFILE
SEE SHEET 17 FOR -DRW4- PROFILE

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PROJECT REFERENCE NO.
U-5907
PNJ SHEET NO.
ROADWAY DESIGN
ENGINEER
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SHEET NO.
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LEGEND
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DENOTES FILL IN ® DENOTES IMPACTS IN
WETLAND SURFACE WATER
� ®
DENOTES TEMPORARY
IMPACTS IN SURFACE WATER
24
O
O
N
PERMIT DRAWING
N
SHEET 5 OF 10
fiETgOLiN WAREHOUSE, LLC

STANDARD 3.5' BASE DITCH PROJECT REFERENCE NO. SHEET NO.
0 W/COUNTER-SUNK
SPECIAL LATERAL 'V' DITCH CLASS 'I' RIP RAP U-5907 /0
SEE DETAIL 3, SHEET 20.1 Ei-. EST 11 TONS Ki m I ey >>> H o r n P� SHEET NO.
EST 10 SY GFD ON
BANKS ONLY ROADWAY DESIGN HYDRAULICS
\\ +\ QOE DDE = 3 CY ENGINEER ENGINEER
GRADE TO DRAIN 200 SOUTH TRYON, SUITE 200
SEE DETAIL 5, SHEET 20.1 CHARLOTTE, N.C. 28202 •;;RN CAIp��%,�,
42"RCP-IV HWSEAL
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EST 20 TONS \ CB \ 15" RCPl 41 UNLESS ALL SIGNATURES COMPLETED
EST 39 SY GFD
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RETAIN EX�S" F CONTRACTOR TO INSTALL
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THE DAVIDSON
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EPISCOPAL
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LEGEND \ I
® DENOTES FILL IN ® DENOTES IMPACTS IN
WETLAN- 1
D SURFACE WATER RAEFORD AND
Q ®DENOTES TEMPORARY SONS, LL .
IMPACTS IN SURFACE WATER 1, 41*50 ISHEET g1
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PERMIT DRAWING �ATCHLINE
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STANDARD 3.5' BASE DITCH PROJECT REFERENCE NO. SHEET NO.
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® DENOTES FILL IN ® DENOTES IMPACTS IN
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SONS. LL
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PERMIT DRAWING
N
SHEET 8 OF 10
�ATCHUNE

WETLAND AND SURACE WATER IMPACTS SUMMARY
WETLAND IMPACTS SURFACE WATER IMPACTS
Site
No.
Station
(From/To)
Structure
Size / Type
Permanent
Fill In
Wetlands
(ac)
Temp.
Fill In
Wetlands
(ac)
Excavation
in
Wetlands
(ac)
Mechanized
Clearing
in Wetlands
(ac)
Hand
Clearing
in
Wetlands
(ac)
Permanent
SW
impacts
(ac)
Temp.
SW
impacts
(ac)
Existing
Channel
Impacts
Permanent
(ft)
Existing
Channel
Impacts
Temp.
(ft)
Natural
Stream
Design
(ft)
1
30+06/30+20 -1-1- (RT)
Embankment Protection
< 0.01
< 0.01
11
7
1
30+20 -L1- (RT) / 32+28 -L1- (LT)
Fill / 48" RCP
0.03
0.01
192
2
32+92/33+15 -1-1- (LT)
Outlet Protection
< 0.01
< 0.01
15
10
3
11+15/11+17 -1-3- (LT)
Outlet Protection
< 0.01
< 0.01
10
5
4
15+23/15+35 -Y3- (LT)
Fill / 36" RCP
< 0.01
< 0.01
3
10
TOTALS*:
0.03
0.02
< 0.01
231
32
0
*Rounded totals are sum of actual impacts
NOTES:
2018 02 26