20140516 Ver 1_401 Application_20140514

CAROLINA
ECOSYSTEMS, INC.
May 22, 2014
Mr. John Thomas
Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
20
1405
1 6
2 r
-
- G
3040 NC Hwy 42 West; Clayton, NC 27520
P:919- 606 -1065 — F:919 -585 -5570
RE: Pre - Construction Notification: Nationwide 12 & General Certification No. 3884 PAID
Highway 66 Water and Sewer Improvements
City of High Point
Davidson, Forsyth, and Guilford Counties, North Carolina —
Dear Mr. Thomas; alVd
The City of High Point is planning to provide water and sewer service to an area located in
northwest High Point along Highway -66 near the US- 311/I -74 interchange (Figure 1). Enclosed
is an application for a Section 404 Nationwide Permit 12 and General Certification No. 3884 for
impacts associated with the construction of a water line and gravity sewer line.
Impacts to waters of the U.S. are 275 linear feet of temporary stream impacts and 0.04 acres of
wetland impacts. Stream impacts consist of sewer construction and a 15 -ft maintained at -grade
crossing of each stream. As discussed during our field meeting, these low water crossings are
presented separately as permanent structures, but temporary impacts, to differentiate them from
the temporary construction areas. These low -water fords will not impede flow or aquatic
passage, but the stream banks will be stabilized, as shown in the attached plans, to allow mower
access across the streams. Permanent wetland impacts of 0.01 acres will result from clearing,
excavation, and maintenance of forested wetlands within a 15 -ft permanent maintenance
corridor. Temporary wetland impacts include clearing and excavation of the construction
corridor (0.01 acres) and construction access (0.02 acres). All disturbed wetland areas will be
returned to pre- construction elevations and seeded. Temporary wetland impact areas within the
sewer corridor will not be maintained and will be allowed to regenerate into forested wetlands.
Impacts associated with the temporary road access for construction equipment will be restored to
grade and reseeded with appropriate wetland seed mix. The temporary construction access is
required to avoid conflict with construction of Project Foresight, which will be the initial user of
the sewer service. That site construction will be ongoing when the sewer needs to be built.
Alternate access around the north side of a pond on the Project Foresight tract is not practical as
there are larger wetlands in that area. While the proposed water line will not impact Clean Water
Act jurisdictional waters, due to the use of directional drill, a small, exempt, buffer impact has
been included in this PCN.

Mr John Thomas
May 22, 2014
Page 2 of 2
The preceding information, along with the enclosed Project Information Sheet, Pre - Construction
Notification, Vicinity map, USGS map, NRCS map, Impact Locations map, and engineering
plans are being submitted for your review of this project Also attached is a revised Preliminary
Jurisdictional Determination request and associated delineation information adjusted to reflect
the proposed corridors
If you have any questions or need additional information please contact me at your earliest
convenience at (919) 606 -1065 or phil.may @carolinaeco com
Sincerely,
Carolina Ecosystems, Inc.
Philip May
Senior Environmental Scientist
Attachments
Project Information Sheet
Pre - Construction Notification Form
Figure 1 Vicinity
Figure 2 USGS
Figure 3 NRCS
Figure 4• Impact Locations
Figure 5 Impact Sites
Engineering Plans
PJD Request
cc Strib Boynton, City Manager, City of High Point
Sue Homewood, NCDWR, Winston -Salem Regional Office
Ben Palmer, P E, Davis - Martin- Powell & Associates

Project Information Sheet
Project Name Highway 66 Water and Sewer Improvements
3040 NC 42 West, Clayton, NC 27520
P•949- 606 -1065 — F 919 -585 -5570
Date: 5/22/14
Name of Property Owner /Applicant Strib Boynton, City Manager, City of High Point
Consultant/Agent Carolina Ecosystems, Inc
Related /Previous Action IDs None
Site Address N/A
Subdivision Name (if applicable) N/A
City High Point, NC
County Davidson, Forsyth, and Guilford Counties
Lat 36 0198
Long -80 0512
USGS Quadrangle(s) Kernersville
River Basin(s) Yadkin and Cape Fear
8 -Digit HUC(s) 03040103 and 03030003
Nearest Stream(s) Rich Fork and West Fork Deep River
Directions to Site From Raleigh, take 1 -40 West Take exit 203 to NC -66 toward Kernersville /High
Point Turn left onto NC -66 and follow to project site
Requested Action
❑ Pre - application Request
® Jurisdictional Determination Request ❑ Final ® Preliminary
® Permit Application ® Nationwide 12
❑ General
❑ Individual

,o`'Q� wAr�R4G
- r
,SIT
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page I of 13
PCN Form — Version 1 3 December 10, 2008 Version
Pre- Construction Notification C Form
A. Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
®Section 404 Permit ❑Section 10 Permit
1 b Specify Nationwide Permit (NWP) number 12 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
® Yes
❑ No
1 d
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
1'g
Is the project located in any of NC's twenty coastal counties If yes, answer1 h
below
❑ Yes
® No
1h
Is the project located within a NC DCM Area of'Environmental Concern (AEG)?
❑ Yes
® No
2
Project Information
2a
Name of project
Highway 66 Water and Sewer Improvements
2b
County
Davidson, Forsyth, and Guilford Counties
2c
Nearest municipality / town
High Point
2d
Subdivision name
N/A
2e 'NCDOT only, T I P or state
project no
N/A
3
Owner Information
3a
Name(s) on Recorded Deed
City of High Point
3b
Deed Book and Page No
Easement to be acquired by city
3c
Responsible Party (for LLC if
applicable)
Stnb Boynton, City Manager
3d
Street address
P °O Box 230
3e
City, state,,zip
High Point, NC 27260
3f
Telephone no
(336) 883 -3289
3g
Fax no
3h
Email address
Page I of 13
PCN Form — Version 1 3 December 10, 2008 Version

4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent ❑ Other, specify
4b
Name
4c
Business name
(if applicable)
4d
Street address
4e
City, state, zip
4f
Telephone no
4g
Fax no
4h
Email address
5
Agent/Consultant Information (if applicable)
5a
Name
Phil May
5b
Business name
(if applicable)
Carolina Ecosystems Inc
5c Street address
3040 NC Hwy 42 West
5d
City,, state, zip
Clayton, NC 27520
5e
Telephone -no
(919) 606 -1065
5f
Fax no
(919)- 585 -5570
5g
Email address
phis may @carolinaeco com
Page 2 of 1.3
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)
Multiple - see plans
lb Site coordinates (in decimal degrees)
Latitude 36 0198 Longitude - 80 0512
(DD DDDDDD) ( -DD DDDDDD)
1c Property size
10 acres
2 Surface Waters
2a Name of nearest body of water (stream, river, etc ) to
Rich Fork and West Fork Deep River
proposed project
2b Water Quality Classification of nearest receiving water
C and WS -IV
2c River basin
Yadkin and Cape Fear
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
Land use within and adjacent to the proposed water line is primarily roadside right -of -way, cultivated land, forestland , and
some comercial and residential development Land use within and adjacent to the proposed sewer line is primarily
forestland and cultivated land
3b List'the total estimated acreage of all existing wetlands on the property
0 04,acres within the project limits
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
315 linear feet within the project limits
3d Explain the purpose of the proposed project
To provide water and sewer service to an area located in northwest High Point along Hwy -66 near the US- 311/1 -74
interchange
3e "Describe the,overalliproject in detail, including the'type,of equipment to be�used
Installation of 9,200 LF of 12 "gravity sewer that connects to existing City of High Point public sewer and extends north to
serve the Hwy 66/1 -74 Area installation of 23,000 feet of waterline primarily along roadside right of way to serve the
same area Construction will be accomplished using typical equipment including excavators, backhoes, pans, and
dumptrucks Additional equipment may be used as required
4 Jurisdictional Determinations
4a Have' jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
,project (including all prior phases) in the past
®Yes El No No ❑
Comments Preliminary JD was field verified April 9, 2014
Revised Preliminary JD is attached A JD for Project
Foresight was completed by others
4b If the Corps made the jurisdictional determination, what type
❑ Preliminary ❑ Final
of determination was made?
4c If yes, who delineated the jurisdictional areas?
Agency /Consultant °Company Carolina Ecosystems Inc
Name (if known) Brian Smith Phil May, and Joe,Sullivan
Other
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations, and attach documentation
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
Page 3 of 13
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
Page 4 of 13
PCN Form — Version 1 3 December 10, 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
® Wetlands ® Streams - tributaries ® Buffers
❑ Open'Waters ❑ Pond Construction
Page 5 of 13
PCN Form — Version 1 3 December 10, 2008 Version

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
W1 ®P ❑ T
Clearing and
Excavation
Headwater Forest
® Yes
❑ No
® Corps
❑ DWQ
<0 01
W2 ❑ P ®T
Clearing and
`Excavation
Headwater Forest
® Yes
❑ No
® Corps
❑ DWQ
0 01
W3 ®P ❑ T
Clearing and
Excavation
Headwater Forest
® Yes
❑ No
® Corps
❑ DWQ
<0 01
W4 El P ®T
Clearing and
Excavation
Headwater Forest
® Yes
❑ No,
® Corps
❑ DWQ
<0 01
W5 ❑ P ®T
Construction
Access
Headwater Forest
® Yes
El No
® Corps
El DWQ
0 02
W6 ❑ P n T
❑ Yes
❑ Corps
❑ No,
❑ DWQ
2g. Total wetland impacts
004
2h Comments Wetland impacts are 15' permanent maintenance corridor and a,40' temporary construction corridor Impact
site W1 impacts 0 005 acres W2 impacts 0 01 acres W3 impacts 0 002 acres W4 impacts 0 006 acres W5 impactsnare
associated with a temporary road access for construction equipment The wetland will be restored to grade, reseeded with
appropnate,wetland seed mix, and should not conflict with Project Foresight
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
34
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)
S1 ❑ P ®T
Sewer Crossing
UT to Rich Fork 1
(SC)
® PER
❑ INT
® Corps
El DWQ
5
28
S1 ❑ P ®T
Low Water Ford
UT to UT to Rich
Fork 1 (SC)
® PER
❑ INT
® Corps
❑ DWQ
5
15
S2 ❑ P ®T
Sewer Crossing
UT to Rich Fork 2
(SB)
® PER
El INT
® Corps
[-I DWQ
4
26,
S2 ❑ P ®T
Low Water Ford
UT to Rich Fork 2
(SB)
® PER
❑ INT
® Corps
[:1 DWQ
4
15
S3 ❑ P ®T
Sewer Crossing
UT to Rich Fork 3
(SA)
❑ PER
® INT
® Corps
[:1 DWQ
4
26
S3 ❑ P ®T
Low Water Ford
UT to Rich Fork 3
(SA)
El PER
® INT
® Corps
[:J DWQ
4
15
S4 [:J P ®T
Sewer Crossing
UT to Rich Fork 4
(SE)
® PER
E:1 INT
® Corps
El DWQ
4
26
S4 ❑ P ®T
Low Water Ford
UT to Rich Fork 4
(SE)
® PER
E] INT
® Corps
El DWQ
4
15
S5 ❑ P ® T
Sewer Crossing
UT to Rich Fork 5
(SG)
❑ PER
® INT
® Corps
❑ DWQ
5
26
S5 ❑ P ®T
Low Water Ford
UT to Rich Fork 5
(SG)
El PER
® INT
® Corps
0 DWQ
5
15
S6 ❑ P ® T
Sewer Crossing
UT to Rich Fork 6
(Si)
® PER
❑ INT
® Corps
❑ DWQ
6
26
Page 6 of 13
PCN Form - Version 1 3 December 10, 2008 Version

S6 ❑ P ®T
Low Water Ford
UT to Rich Fork 6
(Si)
® PER
❑ INT
® Corps
❑ DWQ
6
15
S7 ❑ P ® T
Construction
Access
UT to Rich Fork 7
❑ PER
® INT
® Corps
❑ DWQ
4
27
3h Total stream and tributary impacts
1 275
31 Comments 15' low water fords wdl,be constructed at the stream bed elevation, with bank, stabilization for mower access
(See detail on sheet 11) S7 impacts are associated with a temporary road access for construction equipment on Project
Foresight (delineated by others)
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
Tem ora r T
01 ❑P ❑T
02 ❑'P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts
00
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed, then 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
P1
P2
5f. Total
5g Comments
5h Is wdam high hazard permit required
❑ Yes ❑ No If yes, permit ID no
51 Expected pond surface area (acres)
5j Size of pond watershed (acres)
5k Method of construction
Page 7 of 13
PCN Form — Version 1 3 December 10, 2008 Version

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 [I Tar-Pamlico ❑Other
Prolect'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
required?
Water
❑ Yes
131 ®P ®T
Line
UT to West Fork Deep River
® No
1833
78
Crossing
B2 ❑P ❑T
El Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
1833
78
61 Comments Perpendicular crossings that disturb less than 40 linear feet are Exempt,under the Randleman Lake Buffer
Rules
D Impact Justification and,Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
The water line was designed to parallel existing road ROW as much as practicaktoiminimize disturbance The water line will
be bored under the stream crossings The sewer line was designed to minimize wetland impacts to the greatest practical
extent Most wetland areas identified in an initial walk- through were avoided Stream crossings have been designed
perpendicular to flow Clearing for the crossings has been minimized to the greatest practical extent while allowing adequate
room for the equipment Low water fords are proposed to prevent future stream bank degradation during maintenance
activities
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Sediment and erosion control measures will be implemented according to NC requirements, and approved by NCDENR prior
to implementation Jurisdictional areas not,permitted to be impacted that are adjacent to construction areas will be clearly
marked with protection fencing or other similar method to avoid inadvertent encroachment Copies of the issued permits and
impact areas will be provided to4he prime contractor and all subcontractors working in or near jurisdictional areas
2 Compensatory Mitigation forimpacts to Waters of the U S or Waters,of'the =State
2a Does the project require Compensatory Mitigation for
❑ Yes ® No
impacts,to Waters ofthe U S or Waters of the State?
2b If yes, mitigation- is required by (check, all that aapply)
❑ 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 8 of 13
PCN Form — Version 1 3 December 10, 2008 Version

3c Comments
4 Complete,if Making a Payment to In -lieu Fee Program
4a Approval letterfrom in- lieu ^fee program is,attached
❑ Yes,
4b Stream mitigation requested
linear feet
4c If using stream mitigation,, stream temperature
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
0 square feet
4e Riparian wetland mitigation requested
0 acres
4f Non - riparian wetland mitigation requested
0 acres
4g Coastal (tidal) wetland mitigation requested
0 acres
4h Comments
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 theinpanan 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
0
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 9 of 13
PCN Form — Version 1 3 December 10, 2008 Version

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
1 a
Does the project include or is it adjacent to protected riparian buffers identified
® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
lb
If yes, then is,a diffuse flow plan included? If no, explain why
Comments Stormwater isibeing directed to existing outfalls which will be slightly
❑ Yes ® No
relocated No new stormwater outfalls are proposed
2
Stormwater Management Plan
2a
What is,the overall percent imperviousness of this project?
<1
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan, explain why Nationwide Permit 12 does not require a
stormwater management plan, additionally project impervious area is minimal (manholes only), and - disturbed areas will
be returned to existing grades
2d
If'this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
❑ 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?
❑ 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
❑ Yes ❑ No
attached?
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 10 of 13
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?
lb 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
❑ Yes ❑ No
letter)
Comments
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
Some development is anticipated to occur within the service area However the size of the line and relatively small
service area will limit the amount of future development Existing ordinances including stream buffers and stormwater
management serve as water quality protection
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
Wastewater will be transported through the City of High Point system to the Westside Wastewater Treatment Plant The
plant has adequate approved capacity for this project flow
Page 11 of 13
PCN Form — Version 1 3 December 10, 2008 Version

5., Endangered Species_ and` Designated' Critical „Habitat- (Corps'Requirement)
5a Wll'this project occur'in or,neapan area,with federally'protected species or
❑ Yes, ®,No
5b , Have you checked with the; USFVN §,concerning-Endangered,Species Act
11 I
6 _ -
® Yes n No
, impacts?i
h
T
5c' If yes „ indicate, the:USFWSaField,Offce you,have,ciintacted
„®"-Asheville r --
up,
"5d =What datafsources did you use'to,determme3 +heth'e' you'rasite would'Impact Eh ange” ed''SPecies,or- besignated Critical .a
Habit6t5-' �” � °
USFWS Websitehttp Mw4W fws gov /raieig'i /species /entylist/davidson himl, forDavidson,County-
USFWS,WebsitehftP /lwww,fw-s gov /ralelgh /species /cntylist/forsyth -html' forTorsyth' County
r,
r ,FU$FWS�V1lebsitehttp !M;�wWfws' gov ' /l eigh/speaes/cntylisUgudbrd html, foriGuilfo�d,County-
'NOrthtGarolina N,atural.Heritage Program,GlSldata�pdated January 20A'4;'°and onsite°habitat reviews - '
- _ 1 _ � ,
,h t 1 °�
w a 91 n or rps_ R` q= u rren ien-tll) ' J � �C - m— �m-`�� - —.• ^1' "6 n(f °u _ II' ° ' u ` - - w' r1111,�1 "�;,' w
6. EsentialFsh HabitatX(C
=
6a 'Will -this, project;occuramyarnearari area designated as essential fish'habrtat�'
'Yes{ �, , y , ®,No _
n _
"hJfIyY1'� III-,
6b r What,data soureeidid <youru_se toI detefmme whether your iite�wogId impact °Essential$Fish•Habitat?° -
_ ' - '"itl
NOAA,EFH- mapper' _
" 7., :Historic oi;Prehisto�ic,Cultueai "Resources: {Corps Requiremen'tjf"';,,
7a` Will this'project occurimo( near aniafea that the ?state,federal4of tribal,
govern ments vhave .designated,,as,havmg;histohi ,dr cultural ',presdrvation�-
' °
_status e<
( g �,NationalwHistonc Trust- designation,o� propertiesssigrnficant m°
-
allorth'Caro I history and4rchaeolo, gy)?'
G
.7bry What�data, sources, dldyouuseao; determin e whether- yoursite Would, Impact° historic, or, archeological-resourcesP
5., Endangered Species_ and` Designated' Critical „Habitat- (Corps'Requirement)
5a Wll'this project occur'in or,neapan area,with federally'protected species or
❑ Yes, ®,No
5b , Have you checked with the; USFVN §,concerning-Endangered,Species Act
11 I
6 _ -
® Yes n No
, impacts?i
h
-
5c' If yes „ indicate, the:USFWSaField,Offce you,have,ciintacted
„®"-Asheville r --
up,
"5d =What datafsources did you use'to,determme3 +heth'e' you'rasite would'Impact Eh ange” ed''SPecies,or- besignated Critical .a
Habit6t5-' �” � °
USFWS Websitehttp Mw4W fws gov /raieig'i /species /entylist/davidson himl, forDavidson,County-
USFWS,WebsitehftP /lwww,fw-s gov /ralelgh /species /cntylist/forsyth -html' forTorsyth' County
r,
r ,FU$FWS�V1lebsitehttp !M;�wWfws' gov ' /l eigh/speaes/cntylisUgudbrd html, foriGuilfo�d,County-
'NOrthtGarolina N,atural.Heritage Program,GlSldata�pdated January 20A'4;'°and onsite°habitat reviews - '
- _ 1 _ � ,
,h t 1 °�
w a 91 n or rps_ R` q= u rren ien-tll) ' J � �C - m— �m-`�� - —.• ^1' "6 n(f °u _ II' ° ' u ` - - w' r1111,�1 "�;,' w
6. EsentialFsh HabitatX(C
=
6a 'Will -this, project;occuramyarnearari area designated as essential fish'habrtat�'
'Yes{ �, , y , ®,No _
n _
"hJfIyY1'� III-,
6b r What,data soureeidid <youru_se toI detefmme whether your iite�wogId impact °Essential$Fish•Habitat?° -
_ ' - '"itl
NOAA,EFH- mapper' _
" 7., :Historic oi;Prehisto�ic,Cultueai "Resources: {Corps Requiremen'tjf"';,,
7a` Will this'project occurimo( near aniafea that the ?state,federal4of tribal,
govern ments vhave .designated,,as,havmg;histohi ,dr cultural ',presdrvation�-
' °
_status e<
( g �,NationalwHistonc Trust- designation,o� propertiesssigrnficant m°
allorth'Caro I history and4rchaeolo, gy)?'
.7bry What�data, sources, dldyouuseao; determin e whether- yoursite Would, Impact° historic, or, archeological-resourcesP
_
HPOWEB Map,Service= °http / /gls,ncdc��gov /hpoweb /=
I
° ,National-Register of Historic Places ' http ° /lwww rips gov /nr %research/ y i
Correspondence -With SHPO.(attached email) -
I° .f8hxi ubn
'8: Flood Zone' Designation -
,(Corps;Requirement),
- "1II�, ,n n
_�
- � „ "`-'h'r1 i�.o` -
8a s1NIILthis project occui, In a FEMA-designated 100 -year floodplain� ®'Yes
e,
h ° rl1 it w' $iii U rt '1n
°Ifeyes; tratorwi'lube Flip.
8b explain how,project,mee_ts4FErMA requiremants'4Coordination with the,loeal;floodipiain =admini q;
performed''andtapprovals acquired #priortoconstrucfion, if niece "ssary =' I''" "u N' "'''
11
�h it "n�ii�;
8c� What,source(s)�,,did you,usepto,'make,the floodplaln= determinations
_ tv p ,k Y
ri^),d F° lood- piain°Ma ra_ m
/Ik (l� r w ,a w
�i " Nor t✓ h° C°w aro_ l ix n a ' ppI" n, c flo'L o drr " a p_ s - com % '111,
'ugnW'8 P''1ukl og
1"y
t a ,1 F 3
- _ . II
j
4�'_ -w
.A- IicanUA ent's,Printed -Name
xt
Page X2 "_f 13 -ti t'� ��'- -- u -
h�� PGN,Forrn -Version 1, 3 December 1,0 2008'V,ersiori.�. ,,,.,,I, ' - -
_

(Adent's,signature, is valid onlyhf an authonzation,letter from the applicant
is "rovided
Page 13 of 13
PCN Form — Version 1 3 December 10, 2008 Version

tk
Pw1,,EI6ay _ __ __ �,��
'Sent:, Monday,�MarAch;17;2014F1155tAM . .
To: Ph -,IMay „
subiject:, RE High,Poinf Hwy,`66,P' ect,
- - - „� _
'P'hil
I'
1, too k,ailodk-at,our maps�,and1,f%les foi ,your - wat&r dild sewver,`l,nes� As,'you_note, the�,Water,line,i6 "'f ie,eiist,ng,toad' right;,_
=I — � r D,r - i - - '�I .✓'
-;of -way is in, a,ci,sturbed,,a'rea'and�wodl`d, not be�of�concernliL" gThe�sewerif ,ne =isielocated,%Vii �injth_e:fioo6pla,n „of a -
creek- There are, noirecorded�sites,, withmethe` sewer�line;. area�and” g, ven' thetnarrow, conf, gufai ,on,,gfTthe,flood'pla,n;�,t -,s ' Y "
unlikely that any archaeolog, cal °s,tesrtki atkvuouldwtie;sel,g,tile for3inclus,on in;the Nat,anallRegister of =Historic,Places4arE�%
prresentor „would- be „affected;bykthe_sewe'CiWe._-if got 'thesewer,line ",praject�for_a= forma !rev,eewuri'derSect,on,106;is
it - — _ - -- s —y _
;would not recomfhen'd'any- archaealog ,cail,nvest,gation,pr+or 6 0rojeat con`structjon
,?�
Please,don.t:hes,ta't4e t it ' questions"
rpolores�A -Ha11 �
fleputy�StatefArchaeolog ,st =,2A E:and' -_
-_
W t~ z wji4u ru "PP
OfFice.of State= Archaeoftg r.rr
` 46219 +MadaServicexGenter�
le = : ° ,ru - RaC 46
(9 i9 },807 =8553 ""- ,h -Pj
„ '(919)71;526�711� {�Fax)�' YI
As,of�October_22; 20T,,t nymeWAe'rna,i address,is._doloresbail�a.ncdcf gov,,L „
a r . 11w "”„ n n,r Cpl -
' ib�
E= Nla,l =toTand =from -me; ,n= connection w ,th,the_transact,ori'of,putilic tius,ne`ss, ,sasub�ec`t�to;the No'rthyCaroiina'PublZ,
J y _ 5 a-. a' j§ r - - J
Records Lavu_and'n a�ld ,sclosed,to�th,rd``part,egk� n _
- ..s.... - = s.,.....,. ".� i' —41
Fr'�in��Phil',May�[nfia, Ito •Phd��May@carolinaeco=comin�r � ' t; � _ ��;� -„ � ”
Sent: Monday,,Marc' li'A- A- ,r2014
� Dolores
Su :L,H 11,P,nt'!H}v` %§ Project
Dolores
_Thanks,fo speaking--withrme this mariimg andrrev,ew,ng;our proles - -a rea�for archaeologicalEsites Attached is a l/,e,riity },c
Map.andddd,a USGS1map�ofl�a,,proposed_sewer ,'line -The' water` 11me�w, 11, be, nstalied, aiongiroads ide�areas,lbutithe.sewer'wlll -_ '.,
' `j�Jl"5:.r �r � - Y — ', ' y fa - � } - - - L.
ti parallel akstreamtas shown 5 Pleas_ e- g, veme, adealh ,f�you�have�an`y.questions STFiankshagain =for looking >at the onsueh
_,short_not,ce` -
Phil
Phil May_
Se n,orSc,entistr
Carolina Ecoiy-_st6ms,-Inc— lqr _ -
3040,;NCIHwy;42West
= Clayton, NC 27520;3'_ @r r le
° _.x1919-} 606"1065�In

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a - -
1) 'Data obtained from DMP'file "Hwy 661SeWer(5=9`57,l4 -,"
2) .Permanent impacmbased on,a 15' maintenance,corridor,
centered on the sewer line
1 e
•
1 41
1
1 e
�e
� s
1 a
e
0
4
Temporary iinpacts (Construction) 26 LF
`Temporary`Impacts (Low Wate�ords) 15 LF
s
e
o°
e
e
1�• ^o w
•
• a m7! m.q
Temporary Impacts (Constfuction)`28 LF
S I Temporary Impacts (Low Water Fords) 15,LF
CAROLINA N ��ConstructionLimits Figure 5: Impact Site(s) S1 & S2
ECOSYSTEMS, INC. 2' Contours
304OrNC 42 Wes "t, Clayton NC 27520 Wetlands Highway 66
P_(919)- 606 -9145 F (919) -585 -5570 Feet
- 0 25 'S0 Wetlands Impacts Water andtSewer,System Improvements
May 2014 °'O r Streams Cjty of High Point
ONW Streams lmp_acts

•
•
•
0
■
0
e
•
•
•
•
■
■
■
e
■ " Notes
It
1) Data�obtamedfrom DMP file "Hwy 66 Sewer(5'- I5 -14)"
s° 2) Permanent, impacts based on a 15' maintenance,corridor
° centered on the sewer 'line
X °o
Temporary Impacts (Cons ruction) 26 LF
.w% �` Temporary Impacts (Low(Water For; s) 15 \
'Temporary I
Permanent I
W2
567 SF (0 01tacres)
,207 SF ( <0 01\acres)
CAROLINA N (Zlconstruchon1muts Figure 5• Impact Site(s) W1, W2, & S3
ECOSYSTEMS, INC. -- — 2' Contours
3040 NC 42 West Clayton, NC 27520 Feet (E) g Wetlands Highway 66
P (919)- 606 -9145 F (919) -585 -5570
0 25 50 ®Wetlands Impacts Water and Sewer System Improvements
May 2014 °� °Streams Crtv of.High Point Streams Impacts

•
•
•
•
•
•
0
■
e
s
•
■
■
e
v
Notes -
1,) Data obtained from DMP file "Hwy 66 Sewer(5- 15 -14)"
2) Permanent impacts based on a 15' maintenance corridor
centered on the sewer line
00
e•
e°
0
■ /re
Temporary Impacts 269 SF ( <0 0Permanent Impacts 111 SF ( <0 O1
��`• eee•
eee
Temporary Impacts (Construction) .26 LF
Temporary Impacts (Low Water.,Fords) 15
e` +.e
e
s
0
0
0
•
•
0
e°
e°
•
e
CAROLINA N Construction Limits Figure 5• Impact Site(s) W3, W4, & S4
ECOSYSTEMS, INC. — 2' Contours
3040 NC 42 West Clayton NC 27520 Feet Wetlands H hwaV 66
%
� � � Streams
P (919)-606-914517(919)-585-5570 i g
0 25 50 Wetlands Impacts Water and Sewer Svstem Improvements
May 2014 Gh� of Htgh Point
�0/Streams Impacts

0 °, ° ft
Notes
1) Data obtained from DMP file "Hwy 66 Sewer(5- 15 -14)"
2) Permanent impacts based on a 15' maintenance corridor
centered on the sewer line
•
■
e
■
e
■
s
0
•
■ � \��mp(Construction) 26 LF
Jemporary`Impacts Low Water Fords) 15 LF
e
e
•
0
11 `o
•4b
0
0
0
♦
♦
CAROLINA nj ���Construction Limits Figure 5`: Impact Site(s) S6
ECOSYSTEMS, INC. 2' Contours
3040 NC 42 West, Clayton NC 2752b 4M Wetlands
P (919)- 606- 9145'F (919) -585 -5570 Feet Highway 66
0 25 50 Wetlands Impacts Water and Sewer Svstem Improvements
May 2014 ° %v Streams City of High Point
Streams Impacts

Notes
1,) Data obtained from DMP file "Hwy 66 Sewer(5- 15 -14)"
2) Permanent impacts,based on a 15' maintenance corridor
centered on the sewer hne
27
CAROLINA N Construction Limas
Figure 5: Impact Site(s) WS & S7
ECOSYSTEMS, INC. -- 2' Contours
3040,NC 42 West, Claytbn NC 27520 Feet 42N) Wetlands Highway 66
P (919)- 606 -9145 F (919)- 585 -5570 g
_ - 0 25 50 ®Wetlands Impacts Water and Sewer System Improvements
May 2014 • Streams City of High Point
'`►Streams Impacts

urisdictional Determ'ination- Request
�A ,., PARCEL INFORMATION ti
Street.Addr"ess Ncss
City, State - High Point, Nc
County Davidson', Forsyth, and Guilford
,Directions From Raleigh, take 1- 40'West Take exd 203 to NG66 toward Kemersvtlle /High Point,';° -
Tum,left onto NC -66 and,follow to project site
Parcel Index,Nuniber(s)'(PIN)' NIA °
NIA y,
B. REQUESTOR-INFORMATION
a, Name AStnb Boynton; C ;ty Mari_ager y'
Miiljng AddiesS ° P�O BW230 H _Nd�2
igh Point 7280 N ir'
un
'Telephon6aNurr6er - t'(336)'883;3289 -
"Electronic 1VMai l Address : _
Select one 4
I „ain ,thelctirrent °property owner - l
� l 1-a ffi' an Authonzed Agent or Environmental-, Consultapt2
Interested,Buy "error Under, Eontract to Purdhase
J Other, please,,explain: -
l L=
,� ,Rubllci ;municipal project- "Easernents?,ivdl be.acqulredacross all properties
_C. PROPERTY OWNERINF®RVIATI®N
Name., 3 varies
Mailin2FAddress
Telephone Numbeir
Electronic= MaihAddress,
Proof of Qwnership,Attached(e g a copy of Deed, County GIS /PaTCeUTax.Record -id ta)1_ „
`lf'avallable
z'Must attach completed Agent Authorization Form
- - 3If available
Version A cejnber 2013 -Page j3

it
___ Jurisdictional- Determ�ination'Request
Di ' ,TkOPERT -Y ;OWNER CERTIFICATION° v'
I, theundersigned,,a,duly authorized ownernof record of the property/,properties,identifiedherein,
do authorize- repiresentatives of the`Wilinmgton Disthct, U S Army Corps of Engineers (Corps)
to.enter,iupon the,property herein descr bed,for,the purpose ofrconducting on- site- inuestigations
and,,issuing a deteimination associated =with Waters of the US - subject to Federal, jurisdiction
under Section404yof t'he- ,CleanRWater Act and/or SectionO0,of the Rivers andrHarbofsAct of
Property Owner - (please print) - Date
Property Owner,Signature �� - J
E.- 3URISDICT- -IONAL DETERMINATIONTYPE
Select,One:- r-
11 ,am, requesting thattheaCorps prourd`e, ?afpreliminary JD'for the,,property,,identQfied herein.
Thisnrecjuest;d`oes fmclud'e'a' delineation
'F� I arri iequestmg tliat;thewCorps,provide a.preltminiry JDnfor the�properry:l6n6fied'herei'
Thls,request does NOT�include a delineation
,FI I am requesting, thatxthe, Coipsiinvestlgate,Cthe3property /project arewfor,the,presenceor,
absence of WoUS, 'and,provide'an9approved JD,for the,property identifed'herein' This z
i equest dodskNoT `include a request fo% a verified - delineation - -
E, Y-
,i I am, requesting that, the, Co_ rps= delineateoth'eboundanes,ofgall ViWoUS omen ,property /project -
�� :areaand'proyiiiel�an',a roved JDt this'nia orma notsinclude a -surve lat �"
- IQam requesting, that the Corps-e�,aluate and approve.a delineation of WoUSt(conducted
b =?n-p�propefty�prqjecvarea and, rovtde,ama roved JD ma , or4ma ,`not Y ,P PP ( Y Y incrveyplat) -
1, For,,NCDOT requests,foilowing the current, NCDOT %USACErprotocols r sk_ip,to Part,E `
- - 5Maters of the
_ Umted �States
Version-- December 2013 - �
w n ,
Page 4
k
t � f

` h
i 'd
Jurisdic' tiona1,,Determ'in_ation�,Request,
F. AL`-LIREQUESTS
Fv4 `Map of,Property,or,Project,Area {attached),, This Map must clearly depict the boundaries
of theI1*a,of'evalu4i6n
FSize of Property.or °Project Area, 9- acres
I,verify that the property {or project),boundaries,have recently been surveyed, and marked
by`°a7licensed land' surveyor' OR�are- otherwise_clearly`marked or-distinguishable.
m '
G. :JDrREQUESTS FROM�,CONSULTANITS ORtAGENC1iES
I i c y
(1), PreliminarylJD Requests
t
Completed.a_nd' signed: Prelim` inary ;Jurisdtctiondl'Detercrimation °Forme ,
91 " ,
Prdject Coordinates 36 0198 )latitude -80 +0512 Longitude
Ma' sOotlarg&,than' 14 il' ?) ,with;proiect'Boliddalw� verl"ay, ,
j Large ; and 'small_`scale,maps,that,deptet, at :minimum- _sfreelEL'triier§ections; towns
a -
°t
' ° ✓� __Aei>al Photography ofthe projectare4,
dI
o USGSt opographic Map
Sotl�Survey�Map
Other-Map
s,;as.appropr'iafe; {e''g,, Nationai-Wetland iifventory -Map; Ptoposed Site
Vlari;,previous`delineation maps, �LIDAR�maps ,'FEMA�floodplain-maps)
_f ,
6_See'4ppendix,,A,of,this+,JFprm ,From' Regulatory Guidance Lett6?,No- 08.02 - ,dated 1une�26,F2008 s
Vers- -ton - December'201'3F °' ^ �� '' '`�l °" Page °5'

Juris'dictiona'i Determination- Request
Delineation' Information, (whennapphcabl'e)�`
Wetlands Tributaries
o, Wetland DataSheets8 "US�ACE Assessment-Forms
�r
Uplan&Data Sheets Other Assessment 9rms
(when, appropriate)
Landscape Photos, i f taken
'Field Sketch overlain on legible Map,that includes
® All aquatic ,resources,(forrsites,,with multiple resources,.latiel- and.lden,t fy)
® Locatibns,4wetland data points and /or tributary assessment reaches j
Locations,of photo stations
® Approximate acreage %linear- footage of aquatic,resources
(2) Approved JDs including Verification,ofa Delineation:
❑ Pioject Coordinates.- Latitude _ Longitude
Maps,(no,larger than 1,1 x17) with Project= Boundary Overlay-
❑, Large and'small scale maps that depict, at minimum. streets, intersections, towns
❑ Aerial Photography of the projecttarea
❑ USGS Topographic,Map
❑ Soil Survey Map
❑ Other Maps, as appropriate (e g National Weiland,lnventory Map, -Prop osed,Stfe,Plan,
previous,,delmeation maps) -
1987 Manual Regional, Sup Rplements and Datai4orms,can,be,found at
http / /www usace'army md/ Wllsslons/ CIvIIWorks/ ReeulatoryProsramandPermits /ree, suoy aspx
Wetland and S ream'Assessment,Methodologies c5wbe found at
http / /portal ncdenr orp/c /document library /pet file)uuld =76f3c58b dab8= 4960 -ba43 -4561 fafo6f4c &groupld= 38364,and,
http / /www sauVusace army md/ Portals /59 /dots /re�ulat6ry/gubiicnotices /2013 /NtS M' Draft User- ,Nlanuai'`13o318 pdf
a IDell' neationanfor ,mation,must.lnclude, at "mlmmum,-one wetland data sheet,for,,each,wetland %community type -_ k
Version Decemb °er12013 -,Pa&e 6
l ,

furisdict'ion4l Dgt Emx,,t�q�
Dehneation,fnformation, (when -applicable)
Wetlands:
❑' Wetland Data Sheets
❑ Upland Data, Sheets
est
Tributaries.
n USACE Assessment Forms
_Other Assessment Forms
(when appropriate)
❑ _Landscape Photos; if taken
_ Field Sketch overlain on�legible-Map.that includes
F]
® All aquatic resources,(for srtes,with`mulfiple resources, label and identify)
® .,Lgcatibns,bf Aetland,dita,pomts nand /6r.tributary-assessmentreaehes
o „Locations (if_photo,stations
®_ Approkifnate acreage /linear footage o_f-aquatic,resources
_ Suppoitmg Jdrisdictional In formation, (for Approved JDs only)
'❑_ Approved Jurisdictional- Determination Form(s) (also <known as— Rapanos
Forms
Map(s) depicting,the.potential (or,lack of potential) hydrologic connection(s),
_adjacency -etc to- navigable waters
9' b-elmeation,informationFmust include,,atimmimum,-one,,wetland data;sheet for ekh_wetland /Community�type
Version: "December;2013 -_ ���� "� °�� - - - °�
' Page,7

_ Juri`sdictlonal Determinafion� °Requ'est �; JI L _
L REQUESTS, ,-FOWCORPS APPROVAL OF,,SURVEY PLAT
Prlorto,final production, ofa P14t,-,the W,ilinington�, District recommends thaghe%Land
Surveyorpirlectronically submit aAraft of a,Survey,Platito- theCorps project!inanager,,for
review
- Ir
Due to$storage�ltmitationsrof our,,admiriistrative,records, th_e,`Corps requires, that all hard-
"' copy ,subiriittals -include,atTleast one,brigAn' Nati(to'scale) that is -no larger than l l "'xl7"
_ ' _ _ -� JIAi "'16dIUry
(theluse offbatch -Janes fovlarger tracts "acceptable). Additional,copies of a plat,'including
those larger'than' 11 "x1,7 "; may also be,lsu6itited, for,Corps signature as needed, The
Corps=alsa_accepts electfdntc,submtttals "ofptats, such as those transmitted as a Portable
Document"Format,(i?D f *iA le.y zUpon,,ver`tf cation, the Corps,can, electronically sign these
_ plats and teturn'them via °e - mail -to therrequestor:5
2(1) �PLATS,SUBMITvTED FUR APPROVAL
o_ Must,be sealed'andaignedi�by a licensed,professtonal -land surveyor
Must:be_to°scale-(afl maps'mustanclude both ,a graphic scale and,a-,verbal scale)
Ti Must be4gibl`e_
.Uusf include,a North-Arrow,- Scale(s), Title, Propery Information-
- Must - include atlegible WoUS Delineation Table of distances,and bearings /metes
and bounds %GPS coordinates of.all surveyed -del meation.points
Must�clearly depict -st rveyedjpr6perty of project Boundaries
Must-,clearly identifyahe known_ surveyed,potnt(s) used as- referencel(eYg property
�;coiner,iUS_ GS,monument)
r
F 41
°Vhen�wetlands areedepicted
-�; -
0 Must includd1cfe4ge (orisquare:footage),of weti''dapolygons
® Must identify „each,wetland,polygon,.usmg antalphanumeric system
V'ers2ori 'Decerritier 2013, - _ Page 8

uJur_ isd�ictional ''D,eter�minatlon��Request
FI When tributaries-are'deprcted
• Must.mclude either a surveyed; approximate centerline of tnbutary'with .
approximate width of tributary OR surveyed Ordinary High Water Marks
(OHWM) =of,tnbutary
• Must identify each tributary using awalphanumenc system
• Must mclude,lmear footage of tributaries,an& calculated 'aiea= (usingapproxrmate
widths orsucveyed OHWM)
• Must include name of tributary (based on the.most, recent USGS topographic
map) or „when no, USGS name�exists, rdentrfyras, "unnamed tributary"
'F_1 all_depicted WoUS' (wetland polygons, and tributary lrnes),must`mtersect'or�tie -to
surveyed,proj ect/property 'boundaries
Must include the location of wetland' data points and /or tributary assessment
reaches
Must include, label accordingly; andodeprct acreage,ofall'waters not,curren_tly
subject totthe,requirements -of the CWA (q ,g `- isolated wetlands'~,-"non-
jurisdretional waters” )�, NOTE, An,approved JD must tie conducted in order to
make,an official Corps-determination that a particular waterbody_`or wetland,is'not
junsdretrorial
_ Must include-and survey alfl existing conveyances =(pipes,.culverts; etc ) that
transport WoUS
Version ,December 2013 _ Page 9

n YY
_ J,urisdictional „D,eterm>ination Request
(2�y, CERT'IF'ICATION LANGUAGE
hen�the ,ent►re,actual_Jurisdictional Boundarv,isAepicted:
includ'eitlie;following C6rps�Certification 'language
"This cei4if►esatfhdt this {copy of this plat,accuratelypdep►cts the'`boundary, df `the junsd ►ct ►on,
,of Section 404 of°the,Clean,Water, Act as determined by- the,,unders►gned'on,this.date,
Unless there rs,achange Athe,'law br, our, publishedpregulat ►ons,a the, determ►nat►on of
Section 404,jur►sd►ction may be,relied,upon fora period not, to_ex'ceed, five (5 kars'Abm,
this date Thewn "tlersigned'completed this determination�fut►l ►zing the appropnate;Regiondl
Supplement -to tiie71987sL) 5',Army,Corps`of Engineers +Wetlands Dehneation Manual
Regu/atory,Offic►al
Title
Date
USACE Action !D No
When,upland"smay,be p"resentwithin a,depicted'Jurisdictional Boundart,
include the following Corps, Certification language.
"This certifies that this copy of, this plat identifies,all•oreas of'wa'ters of the UnitedirStates
regulated pursuant-to Section 404 of theZiedn Water Act as'determined by the
undersigned on this date Unless there is change in the,Jawor our published regulations;
this determination of Section 404 jurisdiction may be rehedtupoh for a period `not to exceed -
,five years from this date The undersigned,,completed this determination utilizing the
appropriate,,Regjonal Supplement to the „1987 U S ,Army.Corps of Engineers =Wetlands
Delineation Manual -”
'Regulatory Off►c►dl
Title
Date
USACE Action,lD,No
Version becember 2013 `Page 10

Jurisdictional Oeter-minationf Request,
(3) �GPS-SURVEYS
Fbr;Surveys�prepaied using ,a,Global`Positioning,System (GRS); the Survey musVinclude
allrof the, above,ras weR as`
F
a beat sub -meter accuracy}at each,survey point
4include_an,accuracy verif cation
' One or more known points, (propertyrcomer, monument), shall be „focated with the
,;`GPSzand cross- referenced'with° the, existing ,traditionalfproperty,sur hvey,(metes'and
Lj
` ` include -a brief descr`iption.ofthe GPS equipment utilized

ATTACHMENT A
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUNDINFORMATION
A. REPORT COMPLETIONZATE, FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):
B. NAME ANDADDRESS OF PERSON,REQUESTING PRELIMINARY JD:
,Stub BoyntonpChi'Manager
C. DISTRICTOFFICE; FILE,NAME, AND,NUMBER:
D. PROJECTtLOCAT1gN(8,) AND`BACKGROUNDgINFORMA�� ;ION:,
On'NC -66 betwedn'Payne,Rd `nd;Hed6ecoCk1Rcf in Kemeravdfe and High Point Davidson Forsyth and Guilford Counties, NC
(USE,THE,ATT-ACHED- TABLE,,TOIDOCUMENT MULTIPLE,WATERBO,DIES,AT DIFFERENT
SITES)
State NC County /parish /borough, Davidson, Forsyth, Guilford City High Point
Center coordinates�of,site (lat/long� in, degree decimal format) -
Lat 360198 °N LOng -800512 ow
r
U, iyersal Transverse Mercator-
Name of nearest Naterbody -Rtch.Fork and West Fork Deep River
Identify, - (estimate)- amount,of waters in the review area
Non- wetland-waters
288 linear feet 4 width (ft) and /or acres
Cowardm Class Rrvenne
Stream, Flow Perenmat
Wetlands 002, _ acres
Cowardin,,ClaSs Forested
Name of,any -water, bodies ontthe,.site that- have,been identified as ?Section 10
waters
Tidar
Non=Tidal=- - -

"E. REVIEW PERFORMED FOR 'SITE EVALuAT,!011! (CHECK ALL T14AT
APPLY):
M,' Office (Desk) Determination Date,
F)eld "Determination Date(s)
- SUPPORTING DATA. Data - reviewed foh. Orel im inaryJD
(check all, that apply -,checked items;should,be�,included in case file and,
where,checked and requested ,,appropriately. reference sources - below):
a Maps,,plans, plots,or plat sutjmitted by lbron behalf of the
applicant/consultant vicinity Map and Aenai Imagt Map
❑✓ Data,sheets prepared /submitted . by- gr,ori' behalf of the
applicant/consultant ,
Office"concurs with-data sheets/delineatidn.report
H,
Offices oes °not concur,wlth „data sheets /delineation report
❑d Data- sheets.prepared_ y the;`Corps
❑ Corps navigable Waters' study
� U S ,Oeological Survey Hydrologic,Atlas-
1❑ USG&NHD,data,
USGS 8 and -12 digitHUC;maps
QU -S Geological Survey , map(s) Cite, scale_. &,quad name 1 24K Kemersv_ilie
0 USDA,Natural Resources Conger"vation,Service,Sod,Survey
Citation -Davidson County Inset A, Forsyth County Sheet M, and Gudford,County °Sheet 31
❑ National-wetlands inventory map(s) Cite .-name
❑ State /Local wetland inventory map(s) _
❑ FEMA/FIRWmaps
100, yeaffioodplain Elevation' is
(National Geodectic -Vertical= Dat6m�of'1929)
'Photographs ✓❑, Aerial Name , &. Date 2010 Statewide Aerial photographs or
❑ 'Other (Name &�Date)d
❑ Previbu& determination(s) File nno�,and,date -,of responsedetter
Q� Gther,anformation (please�specify)=
'2

I- The Corps of Engineers, believe$ that there , may berjurisdictional,waters of the
United States on the subject site,,and thelpermi't applicant.or other affected -party
who requested this preliminary JD islherebyadvised of his,or her,optron to
request,and- obtain .anlapproved�jurisdictional ,determination (JD),for that site
Nevertheless, the permit;,applic ant, o' r, otherlperson •who�irequested�this
preliminary ?JD has declined ,tomexercise_tho option to obtain amapprovedrJD in
this instance and °at this time
2 In any circumstance•where a permit°applicant,obtams an individuaIAOermit, or
a Nationwide - General Permit�(N k ),,or other general permit verificationrrequinng
"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, of1he
following ;( 1)', thetpermitapplicant °has.eiie6ted to seek a- p {ermit,,authonzation
based on_a prelimina y,,JD, which•does riot %make,an- offcial determination -of
�jurisdictional-waters, ,.ti(2) 'that the�applicant hasAhe,`option to,frequest an approved,
JD before accepting,�the,termssand conditions,of°thwpermit authorization; and.
`that basing a', permit authorization,on,an }approved. JD ;could possibly resultyin Mess_
, Ecompensatory,mitigationibeing; required ,-otE different ,,speciah conditions,, (3j -thaf
"the- applicant,has�the, +right to request, an - individual 'permit,rather,,than;accepting
the term s`,and,conditions.of the_NWP or,othe(general,,permit a6tho6zat16n;r(4}
that,the�apphcant,can acdepfa, Perm it- authorization and1thereby agree,fo comply
with all `th'e3termsiand conditions of that permit; ,including whatever'mitigation
requirements the Corps has determined tokbe necessa-ry,­(5)Fthat undertaking,
any activity mr`eliance upon the subject `permit =F authorization'without requesting
an approved,JD_F 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,aufhonzation jd g °, signing,a ;proffered
`individual; permit) or undertaking-any activity°in rehan'ce,'on any,form of Corps
permit,auth'onzation , based,on,a' preliminary,,JD,constitutes;agreement that:all
wetlands,,and,other;water bodies on the site:affected4h anyway, by-that,activity
are guridictional- ,waters of'the, Urnted�States; and #precludes --any ctiallenge.to
"such �urisdiction,�in any administrative�orjudicial comphance,or enforcement _
°action;,or�in-any administrative, appeal,or rn,,any Fede'ral,�court; -,and, (7) whether
theiapplicant elects to use,either amapproved JD or'a ~preliminary JD, that- JD -
will'be'processed as=_soon as is,,, practicable Further,,-,an approved,JD,,ai proffered
individual permit (and all teams 'a'nd,,conditions contained therein), or- individual
perniit�denial can be,administratively appealed, pursuant to,33 C FR 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 admirnstrative,appeal; it becomes necessary
to make =an_official determination whether rClJA °jurisdiction exists over a sife,,or
to "pt' oxide. an• officiaLdelineation ,ofluhsdictional waters on. the site, the =Cor'p%Aaill,
provide%amapproved 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 protect site, and identifies all�aquatic features on theisite that could be
affected by the proposed activity,, based on the following information
IMPORTANT NOTE:,The informatiom,recorded' on this form,ihas not
Signature -and date,of
Regulatory°Project Manager
(REQUIRED)
4
Signature ,an&,d- te ,of
person ;requesting preliminary_ JD
(REQUIR'ED', unless obtaining
the signatU4,is °impracticable)

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CAROLINA N Figure 4b: Sewer Line Index
ECOSYSTEMS, INC. p Sewer Line Sheet Boundaries
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May 2014 Roads Cih of High Point
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P: (919)- 606 -9145 F:(919( -585 -5570 Feet proposed Sewer Line Highway 66
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�- Epherr�erah ntetmi =Perennial 11
e g Quad,Name.
rf z 19 or erenhml if"? 30'
-- --
3
ri le- 'ool }sequence _ __
„ II
,I
II
' II
Ih,
11 "
Y -
A,FGeomor holo �- ,(Subtotals =, }''`�- )° _
Atisent -:
_ Weak ';
Moderate
_
Strong
`'',1a,C66tmuity`of,channel', ed,and-bank
_ '0 _
1
2
3=
2;',Si6uosdy{oftchannelFalong thalweg___ ,
0
2 -
3' `
3 In'channel,structure e_ x riffle -pool, step -pool; _
0
t1
2
3
ri le- 'ool }sequence _ __
--
°° - '
_ _
4 Particle size of stream'substrate _ _ ` _
0
n
2
3 _
5 .Active /relict floodplairi _
0
1
2
= 3 - _
' 6, „Deposihonal bars or benches _ ELL _ _-
'no
1 -
2
3 -
7_Recent alluvial'deposits - - _ _ —
0 1_
2 _ 3
8 Headcuts - 1 _
1
2' 3 _
9 Grade'control - _� j
0 05, --
=1 5
10 Natural valley =- - - ' - = - �_ �
-- p ”- �0^
1 5-�-
11 Second,or greater order channel
Yes = 3
a artificial ditches are'not rated, see�iscusstons in manual:
BK H drolo '(Subtotal= 15 t
-
��
I '
4 '
0
12 Presence of Baseflow•
Ion oxidizmg�bactena
3` "
eaf ,litter''' - -
1
1
"� j "0 5,
�� „ 0`
Sediment on plants or debris
F-grL�
--
°° - '
Orgamc'debns =Imes or'pde "s' - , _
0
'0`5 „. ,
;
1 5
Sod based evidence,of'high water tables
_ - .v__ - _ ,. .
-
Yes
a,
- I r
= 3 - _
-
��
I '
4 '

%Tg- 1r%1x7n.Q+r.a — Manfifl"*inn 1WnrmVprcinn,A71,1
Date-
-,Projecvsite -
Latitude, 3(o.Df'7f4
Evaluator-
Ciciiiuiinty'
Longitude
v1
roly 1
12
Total'Ro-'Ints•'
least tritermittent 311'.t
Stie'arr Det"df
41;ihm
Other
e 6uaa,Name
'ff'� J'Ephe
L5
glll�
I
"416i perenhial if Z30"
0
L" -
''p,
A,,,,aeomorph61o6y_ (Subtotall,,=" ]�(�
Absent-
,Weak-'
Moderate
,'Strong
1' Corribhudy ofch4nhel,bed'and,baFn_k
0-
roly 1
12
2 Sinu6iity�of channel ,6loOg�th�a 1weg
0
,,1i�-
Routed up I ' d,Olants in'streamWd
11
144 Laf,iter
3 In=dh6nn-el dtrLfctUr6tex .riffle -pool, step-pool,
0
C 5
2
03
npple-"o6rse7qi1e6c6
-
05
1
,21 uiflo' "Mp S
4- i?arttcie ,ke ofttreiim substrate;
0
65—
No,='O
L
1
�Iive/rilii - Plain-
,5 Ac ct flood
0
015
2
'3 -
'6 Depositional bars-ciberictfes
0
2
77aRecehtialluvial,i eooslts'
o-
:'23oCrio
3-
8 Heg&cufs
r
2gj �-�A i Wp 0 6 6
3
GizGrade'166r�troi'
21 1'5__
. '1�07 —
fil- lleye
!1�1. -Nattf ya
0,
1�5
1 - 6&fid1,6r,,, tdi ordo dharinel
I �A�JjS� _ _ _
No=O
—_ - - - -
- TL' / r,
V -.
�6,,attfici'al.ditt6lies are not fated,§�f,dam_ �u ions'inmanual
IB H d I
0
L3.'- Yro�
92'-e
_6AT6fiBase ow
4 n' I A., _WhIr4,�rlw
ILI
iuiuyy- kouULal -
li O tu
F ~
3
-0 -
F66ous Tbts-iri s6iiambed,
roly 1
2,
,,1i�-
Routed up I ' d,Olants in'streamWd
11
144 Laf,iter
C 5
_
-2o-Ma&6666thoC(n6t6 diversity and,abundanc),
03
0
-
""16-'seaiffi6fit.on
05
1
,21 uiflo' "Mp S
1,5
x,16- 'Organic debrisIm6s or Piles-#,
65—
No,='O
L
3- __
-1'6
jable?
1'7 Soil -based evidefice ofhig *4!e�r-
015
1
-1 5
iuiuyy- kouULal -
li O tu
F ~
3
-0 -
F66ous Tbts-iri s6iiambed,
,,1i�-
Routed up I ' d,Olants in'streamWd
2
0
_
-2o-Ma&6666thoC(n6t6 diversity and,abundanc),
03
tt
2
3 ------
,21 uiflo' "Mp S
-2
L
3- __
015
1
-1 5
22 Fish
-
:'23oCrio
2gj �-�A i Wp 0 6 6
05
1 5
Ok5
Al
��--,
,25�Ai§ak
26Y
��FACW =,0 75 1 QBG� 1 5.1q)4herqO
it riiiiy ils 6be iiii6ritifig d using ermethods Seq�,,p_ q5,ofr4riugK':',',
. . .... . .
"Ic
Notes
]jr
Wieh

V y ,
Date „
°��)'
- ° !
Project/Site jta
-
Latitude:
- Il+_m� j�
•Evaluator y tip”
I
County: (Cry 4 t
Longitude:',
i
Total ^Points': V „
"Stream is, at least intermittent ,
Stream Determinationj;(circle one)
Ephemeral 'Intermittent i
Other
e g QuadrName
if z 19 or erennrei d x,30"
- 1 1
_ _
1�
I +
A Geomorphology (Subtotal= ` ' }
1" C6ntinuity ;of,channe1 bed'and,bank
2r _Sinuosify of channel•along,thalweg
Absent t
0
0
I Weak
�1;
� blderatC
;� 2 "j�
Strong -'
`3
13 In- channel structure Iez Inffle -pool, step -pool,
0
1`
-
3
AIW w
ripple-0661, se uence
- 1 1
_ _
1�
_
42 §�-
-
r - - :�
4 Particle sizelof stream substrate
tj
�
_
'5 Active /relict,jloodpialn
1140'
_
"00
2¢,I
3' _
-
'6 'Deposdional,,6rs or benches
No ='0;
-
3
3
7-�Recent;aliuvial''deposits
8 ,,Headcuts""1
=No,='O'-"
2
L9,tGrade control'
_ -
10„'Natural valley �
"b 'greater,order
_
Yes
1 5
=_`3`' _
1J1 Second, channel`
° artificial dltches,are'not ratea, see oiscusponl �ITInanual
ti `H applo JUDioial = t /
12 "Presence of,Baseflow ' ,I
0 1
, „
2
13 'Iron ozldizi6a bacteria
r L 1 -
_
2'
L -3 '
"Leaf litter
- 1 1
-
-
_14
15 „Sediment ,on plants or,debns
0
16 Orgarne,debns hnes,or piles
0 _ -
No ='0;
r F,
5,

°Nf''DWO Stream identifcat onTorm Versiow4A1,
Date
Absent'
�ql "
" ProfectlSite _
Latitude,�ta
Evaluator 1} _
County: _
Longitude —
TotaFPoints'
Stream is at,least+nterm+ttent
if z 19 or perennial if z 30'
Stream Determination_(circ e)
Ephemeral Intermittent erenn
Other
e g Quad Name'
si
A Geomor _holo ; Subtotal, =v* , � �e)
Absent'
Weak
Moderate
`St_rong
1a Gontmuify of d-anne[6 d and bank "
�
0
1
2_ ”
r; 3
'2 ,,Smuosityiof channel,lalong thalweg,
10 �'
, , �'�1
2,
0
,31111n-channel structure ex nffle -pool; step =pool,
ripple-pool se uence
0
1
�^
3
4, Particle §ize- W'stream substrate -
0
1
_
3
5- Active/relict floodplam
0
1
1 y
3
6 Depositional bars,or benches,
01
1
2
3
7 ,Recent aliu_v_ial deposits
0�
ti 1
2
3
;;8 Headcuts y - _° -
1
2
3
1',9' Gradercontrol _ _
0,
0 5 , '
1
1 5
1,110,;Nat6ral valfey-
0`
05,
15
X1'1," Secondor greaterlorder channei�
NO 01
�o
G. 'Blola Subtotal i-
,-artificial ditches,are not rated, „see d+ §c s §ion§ immanual
.R 'Hvdraloov (Subtitai! =. _ ! 11
12 ,Presence of Baseflow
0
1'
2 -
1 ' _ '
13"Iron o cidizing,bactena r
19', Rooted upland�Oants m streambed_ 4
1
2_ ”
r; 3
14 Ceaf litter '_
_ 0
` 20- Macrobenthas .(note�div_ersityand abundance)- _- "
0
0
,15 Sediment`on,planfs_or debris
0
O 5"'
- _ 1,_ _ _
15
16, Organicdebris'Iines °or piles _=
0
`05 -
'1
15
1,7 ' Sbii- basedievidence'iof high` ater table ?' "
Ne= 0
V
'18 'Fibrous roots in- streambed,
r 3
2
1 ' _ '
�� _ 0 _
19', Rooted upland�Oants m streambed_ 4
3,
2'
-Y- '; _
_ 0
` 20- Macrobenthas .(note�div_ersityand abundance)- _- "
0
1
2
_ 3
21- AquaticyMoilusks
0 _
2-' _
3
,22 Fish
23 Crayfsh
{
0
-
0 5'
0 5
1 y
1 5
1 5
24 ,Amphibians _ _
0'5
1 _ _
1 -5
25', Algae
26 ` =Wetland plant`s'in `_streambed
,
0 0 5 1- 1 5,_
„- 'FACW *0 75; OBL = 1 Ottiee= 0 _
'perenmaltstreams may a_lso,tie identified 'usmg?

-NC,DW0-1.qtrenm Identification-ForimVersion 4.11'
Date,'
I-LAI
Project/Site
Latitude
Evaluator
I - -01p, �
County Elo, C4,
Longitude
T6fa1,,P6ih&
Stream DeteTinahb (circle one)
Other
Stpe�prrilts,at least intarmdent -
phemeral ermi!
a g Quad Name
2-
nnPerennial
3-, In-Wafinekstructure -ex nffl-e-000l, step-pool,
nw le- pool,se-quefi-oe,
A Geomorphology -(Subtotal
Absent
Weak
Moderate
Strong
-1' ito--nfin6ty, of '6Kan nell'bied, andba-nk-
0.
2
72)
3
Z Sinuosity ofcfiann-el along Ifialweg
-0
1
2-
3
3-, In-Wafinekstructure -ex nffl-e-000l, step-pool,
nw le- pool,se-quefi-oe,
1 0
1
C2),
3
4 Pdrtide'tLze,of stre-arri,sijbsirate
0
F'
2
3
17,-Soi1-6aged-,eVid6-nce ofohigh WaLtqr,,t _qble?
0
1
3
' 6' Depositional t3ais =or• ,'benches„ Ml
0
1
3
7,,R6-6entialluvialrdepbsits�
0
05
-
3
8 , -H, -eidcuti < <
0
FAGW, = 0 7-5, OBL = 1 5 Other.
3-
t(o(,
1106 )
'05-
-1 5
10 Naf6ral,vzillley
0
1�5
j,'11- Skpo7no Tor, g(e:pter, order channel
-Y4k=,3
4ft t dated, �qns in manua
rtifi6al,ditchesarenb - d s(r,disL-r
f;-PxiAC61bav It'suhtntiii'"=
` ,12-,Pre6e-nqe-of Basefidw
10
1
3;
13,Iron oxidiiTfg,-b-a0&iwj,
L�
2
2
3-
14,L6.1flUtter
0
1
0-5
-----0-,
,15, %dmrlenvon,pIintsbr debris
1
2'
a 3,
22 Figh
0
F'
1 5.
17,-Soi1-6aged-,eVid6-nce ofohigh WaLtqr,,t _qble?
No,= I 0
- Y e--§ = 1 3 _
18 Fbrous,roots in sfreaMbed-
3
12
70
19 Rbdt6dsupli§6d�plAnts,instream6ecf' � —
L�
2
-b
-'20>Microbehthos (note di�6rsity and abundance)
0
1
-(2
3
tit 4AObatic M_ &Usks
1
2'
a 3,
22 Figh
(b-)
05
1 5.
23 Crayfish
0
"24 `Amphibians
05
26 Algae
05
--1,5-
26 Mfeilkdtlplanfs in'str'earrlbed
FAGW, = 0 7-5, OBL = 1 5 Other.
'pf ren-nialisvearrls may"als6 beAentified using other methoWSee p 35 of manual
......... . ......... —
-Nbtes
4
Sketch

I
'.,NC.'DWO'Siream Identifientinn.F6rim Versiafi,4.4 I
'Date:
iol) M
_l2rojectlSitii
Latitude
Evaluator'
County,
Longitude,
-0
1,
2
Total Points:
,Stiea�nlis ,a��least,intermittent
Stream. Determination (c Wde-oqo
I Ephemeral' Intermitte erennial')I,
r�f
Other
eg QqadName,
�
If,;! 19'0rp9r9nnI8IrIf,;-
2
jI
A Geor , horphology (Subtotal
Absent
Weak
Moderate
IfStrong
I a ContAuitF,6f,,ch4hnel bed and bank,
-0
1,
2
3
`2,'SinG6ity'6f,6hihnel along thalwegi
0
.1
2
3
,3 In'- charfn6lstf-Octdre ex raffle -pool; ,ste0-0b6l-,
n0p le- pool sequence
0
1
1-
3
4 Particle size of stream substrate_
0
1
2
3
'5 Advelrelict floodplain
0
05
2
3
6 �Depositfbnallbars or benches-
0
2
7 Recent alluvial deposits
0 -
2
05
8 HeadcUts
25 Algae
2
'9 Grade -control
1
05
1
1�5
10 Natural - valley-
0-5
05
1 --L
1,5
1,11 Second & greater order channel,
No'= 0 -
(Yes = 3--,,
artificial ditches are,pot-rated, see di ussions in,manual
B -Hydrology (S66totil-
f2 Presence cfl§aseflow,
I J8';IFi6rdbg rooti,idl,ifi6arn6ed
0
1
2
(il, - - -
X13' lror,6xidizin4badina
I 9',LR cibted;u p I an d'p I a rifs,i n, ifre a rn f5e&
2
3
1
-'0 5
0,
i 15 'Sediment on plants,or debris
-0
(0 5)
1-
1 5
164aOibanic,ddbris4liffe-s;6r'piles
11
2
�22 Fish
1� 17,;§oil7based!evidence,of- high water table'?
No-=-O
05
I J8';IFi6rdbg rooti,idl,ifi6arn6ed
2
1
-0t
I 9',LR cibted;u p I an d'p I a rifs,i n, ifre a rn f5e&
'
2
ih20:!Macrobeiithoi'(n'ote,aiveriity_irdl-abundance)
0
,21"Aquatic Mollusks
11
2
�22 Fish
05
`23 Crayfish
05.
24 Amphibians
05
25 Algae
0l
0 5
1
115
26 We6hd 'plants,in�strearfibed
FACW = 0 75- OBL = 1 5;,�Pthefr
other methods Seep 35 of manuil
*perennial`streams� may also beidentifiv us�1-65-qtf-
Notes '7Ati%kjjS-
Sketch

pi
NC fDWO Ctrenm fdentifientinn Fnrm Vereinn d_TI
Date 5,A /I LA
yProlecW8de
Latitude � >
' Evaluator•b
Coun
Longitude W `
0
1
2i_ _ _
Total Points:
Stream is at least intermittent (�}
"1 ` '
StreamsDetermmatlom(cir -' ; °
u N
Ephemeral ,Intermittent erennta
Other �
a 4,Quad,Naroe
;rfz 19 or' rennra rf> 30*
'0 5”
20 Mecrobenthos (note dversIty brill abundance)
A Geomorphology, (Subtotal - )
Absent
Weak
;Moderate;
°_ nStefang _- `
1a Continuify_of channelibed and bank
0
1
2i_ _ _
- 3.�
2 Sinuosity!of'channei,along thalweg
2
1'
'0 5”
20 Mecrobenthos (note dversIty brill abundance)
3 In- channel str`u`cture "ex nffie -pool „step =pool,
ripple.zpool sequence
0
15�
_ -_ IV "-
'_ < " 15
4 Particle size of stream substrate
`0
3
5 - Active /relict floodpiain
10
,Yes = 3f-)-
22 Fish
6 ,Depositional bars or benches,
'On
'1'
, 1
7 Recent alluvial=deposits
0
-
_ 2,
3,'
8­'Headcbts
0
_ 1;
2�
;09 Grade control
0
b 5
11 -5
25 Algae
10- Natural valley
0 _
'----405
-(A)
,-
1.1 .Second, or greaterorder channel
No =R0
Yes ',
-_'artificial are not - rated, see discussions'm manual _ �r
B Hydrology (Subtotal= T5
}
',
12'- Presence of'Baseflow
0
127
3
- x3
13 Iron oxidizing, bacteria'
1
2 ' _
3
14 Leaf litter
2
1'
'0 5”
20 Mecrobenthos (note dversIty brill abundance)
15 Sediment on plants or °debris
0
15�
_ -_ IV "-
'_ < " 15
'16 Organic ;elms hriestor piles
0
17 Soil -based evidence of high water table?
No -= 0,
,Yes = 3f-)-
P Rinlnnii. fCi lhfntal
,18-Fibrous roots in,streambed
3
19 ,Rooted upland plants'in streambed,
_
_ 3�_
2
20 Mecrobenthos (note dversIty brill abundance)
_
0 _
_ 111
_2 _
3
21 Aquatic Mollusks
1
2
3?
22 Fish
03
0 5 _ _ _
, 1
23 Crayfish - -
0-
'S _
- _ 1
44 Amphibians _
0%
0 5
1
11 -5
25 Algae
t 0'
05
1 _
115,
26 Wetland plants in streambed
FACW = 0 -75, OBL = -1 5 Other =` 0
*perennial streams may also be`idenbfiedw using ,other methods ,See p 35 of manual
Notes
gin
Sketch

� A wc.V1� +
WETLANDIDETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site City /Countp f� 3 Sampling0ate J /
( +j j
Applicant/Owner tR?in+ f° ip State Sampling PointTtt`
Investigator(s) , s) (+ ,1 lt l If ` (�a � Section, Township Range
Landform "41lsiope, terrace, efc�) - t- A9Lp Local,relie concave, onv_ex, none)' Slope (n %1)
Subregion (LRR or MLRA) Last , ' 0 ° '10° �) Long" , 6 D tum , N10un
Soil Map Unit Name - t�, ,C IA I AJA NWI�classification
Are climatic thydrologic'conditions on;the site,typicabforAhis time of yearn Yes No (if,no, explain in Remarks)
Are Vegetation, , Sod or Hydrology significantly disturbed? f} Are "Normal Circumstances" present? Yes 'y 'No,
Are Vegetation , Sod or Hydrology naturally problematic'7, (if, needed explain any answers in Remarks)'
SUMMARX OF-FIND(NGS - -Attach site,map, showing sampling'pointlocations, transects, important features, etc.
HydrophyticMegetation Present? Yes No Is the Sampled Area -
Hydric Sod Present? Yes '� - No Within,a Wetlands Yes No
Wetland Hydrology Present? Yes _ No
Remarks
}S
MvnDni nr":v
WeUartdu'_H drolo Indicators''
Y a
Secondary Indicators (minimumtof+two- reauired)� , ,
, _ ,gY
Primary Indicators (minimum of one is'reouireb check all that apply)
7 ,
= Surface Soil Cracks,,(B6),
Surface Water-(Al)
_ True Aquatic +Plants (B14)
—.Sparsely Vegetated Concave Surface,(138)u �
_
y. High Wate67able'(A2)
_ Hydrogen Sulfide Odor (G1)
_ Drainage Pattern%(Bi0)
Saturation (A3)'
= Oxidized Rhizospheres on Living Roots (C3)
_ Moss Trim Lines (B16) „
Water Marks (61)
_ Presence of, (C4)
_ Dry- SeasonVater Table (02)
_
_
,Sediment, Deposits (1]12)`
_ Recent Iron Reduction in Tdled,Soils (C6),
— Crayfish<Burrows'(C8)
_
Drift Deposits (B3)
_ Thin Muck Surface (C7)
_ Saturation Visible on Aerial Imagery (C9)
Algal Mat or Crust (B_4)
_ 'Other (Explain in Remarks)
_ Stunted or Stressed Plants (D1)
_
Iran Deposits (B5)
X Geomorphic P6si6on'(D2)
_
Inundation Visible on,Aenal Imagery (B7)
_ Shallow Aquitard (D3)
_
Water- Stained, Le'vesI(B9)
_ Micro[opographic,ReUef (D4)
Aquatic Fauna,(613)
_ FAC- Neutral Test (D5)
Field 06serirations
Yes Depth (inches)
Su_rface,Wafer Present? -No _'I,
Water Table Present? Yes No
Depth (inches) Os
'°
,,Saturation Present? Yes No,
„S Wetland
Depth` +(inches)',
Hydrology Present',, Yes -- No +
includes ca ilia nn e) - -
Descnbe Recorded,Data "(streamigauge „monitoring well; aerial photos, previous,mspections),d available
Reniarks -
n
,
r
'
r
US Army Corps of, Engineers
f
r
Eastern Mountains and'Piedmont = Version,2 0
4
,1
ity
z

VEGETATION_(Four,Strata) — Use scientific names of plants,
Tree ratum (Plot size , F �I r° ) tOX Cover
1 Af-.Q r Nbrum
3
4
5
6
SamplingPoint
Jonnndui inuftdLUJ „ WUIRDI nnL
S eaes? Status Number of Dominant Species
t6af Are OBL FACW or FAC_ (A)
Total Number of Dominant
- - Species Across All Strata (B)
�= Totai,Cover
50% oftotal cover 20 %,of'total cover
Sapli /Shrub Stratum (Plot'size Ljr`,t ? ,
1 -1 t �1y' J ,fn
2
3
4 - - -
_ _761:41 Cover sue_
1 50% of,total cover 20% of totai;cover- er ,
_Herb Stratum, {Plot size )
3n y x
, 4,
5 - -
`10
_T7_ =Total Cover
50% of,totall,cover 20% pf,total cover`_
Woody Vine Stratum (Plot size
,2
4 -
5
Total Cover
el
50% of total,cover :;;> 20% of total cover_
Remarks- (include photo numbersAhere oron acseparate sheet )
US Army Corps of,Engineers
Percenttof, Dominant Species (�
That Are OBL, AM, & FAC (AB)
'Prevalence Index wokstieet
Total % Cover of
Multiply by
OBL species
x 1 = W
FACW,species
x 2 =
FAC species
x 3 =
*ACU species
x4=
,UPL species
X5=
Column Totals
(A) '(B)
Prevalence Index, = B/A = —
1 -=Rapid Test for Hydrophytic Vegetation
2 - Dominance Test is >50%0
_ 3 - ,Prevalence Index is 53 0'
4 - Morphological Adaptations' (Provide,supportmg
data in Remarks or,on a separate sheet)
Problematic Hydrophytic Vegetation' (Explain)
'indicators +of hydnc soil and wetland hydrology_must
be present, unless disturbed or problematic
Tree - Woody plants, excluding vines, 3 in (7,6 cm),or,
morean diameter at breast height (DBH), regardless of,
height
Sapling /Shrub - Woody plants, excluding vmes, less'
than -
,3 in ,DBHrand greater than or equal to,3 28,11 (,11
m) tall
Herb - All herbaceous (non - woody)` plants,, regardless
of`size,,and woody plants less than;3 28 ft tall
Woody vine' - All woody, vines,greateF „than 3'213,6n
height
Hydrophytic
Vegetation
Present? Yes No
Eastern Mountains ,and'Piedmont - Version 2 0

el
'Type C =Concentration D =De letion, RM= Reduced Matrix, MS= Maskec
Grains 2Locahon PL=
Hydric Sal Indicators•
Indicators foi,Problematic Hydric Solis'
_ Histosol (Al)
_ 'Dark'Surface (S7)
Profile Description (Describe to the depth needed todocijmlffli
the indicator or confirm the absence of indicators )
Depth Matrix
_ CoagLPiame Redox (A16)
Redox Features
_ Thm'Dark Surface (S9)�JMLRA147, 148)
(inches) Color moist
%
Color moist
% Type' Loc
Texture Remarks
Depleted,Matnx (F3)
(MLRA 136,147)
— Zbm Muck (Al 0) (LRR N)
_: Redox,Dark Surface (F6)
_ Very ShaI16 Dark,Surface (TF12)
_ Depieted° Below, Dark Surface (All)
= FDepieted Dark Surface (F7)
_Other (Explain in, Remarks)
— Thick,Dark Surface (Al2)
__�Redox'Depressions (F8)
_ Sandy MuckyMinerai (S1)'(LRR+N;,
'Type C =Concentration D =De letion, RM= Reduced Matrix, MS= Maskec
Grains 2Locahon PL=
Hydric Sal Indicators•
Indicators foi,Problematic Hydric Solis'
_ Histosol (Al)
_ 'Dark'Surface (S7)
_ 2 "cm Muck (A10) (MLRA,147)
Histic Epipedon (A2)
_ Polyvalue<Below Surface (S8) (IHLRA 147, 148)
_ CoagLPiame Redox (A16)
_ Black Histic (A3)
_ Thm'Dark Surface (S9)�JMLRA147, 148)
(MLRA 147, 148)
_ Hydrogen Sulfide (A4)
—Loamy Gieyed,Matnx (F2)_
_ AedmonrFl6odplain Sods,(F19)
— Stratified Layers (d5)
Depleted,Matnx (F3)
(MLRA 136,147)
— Zbm Muck (Al 0) (LRR N)
_: Redox,Dark Surface (F6)
_ Very ShaI16 Dark,Surface (TF12)
_ Depieted° Below, Dark Surface (All)
= FDepieted Dark Surface (F7)
_Other (Explain in, Remarks)
— Thick,Dark Surface (Al2)
__�Redox'Depressions (F8)
_ Sandy MuckyMinerai (S1)'(LRR+N;,
'Iron- Manganese Masses (F12),(LRR N,
(MLRA,147;r1�48),
MLRA'136)
= Sandy`Gleyed Matrix (S4)
= 'Umbnc`Surface (F�13) "(iNLRA 136,,122)
''Indicators of,hydrophytic vegetabon,and
_ Sardy,Redox;(S5)
Piedrrio6tsF ioodplain'Sods,(F19) (MLRAy148),
qwetiandlhydrology must be present; "
Stnpped`Matnx,(S6)
=„ Redi ParentlMatenal,(F21) (MIRA 127,147)
unless disturbed onproblemaUc "5
Restnctive,Layer,(rf observed)
Type
Depth (inches) Hydric Soil',Present? Yes No
US Army Corps of Engineers, Eastern Mountains and Piedmont - Version,2 0

WETLAND DETERMINATION.DATA FORM Eastern Mountains and Piedmont Region
Project/Site rt City /County rs,' � Sampimg}Date !
Applicant/Owner t � tr~ State _ Samp ing,Point'
Investigators (,J(io, Section, Township, Range
Landfo (hdlslope, errace, etc) . Local relief (concave, convex none Slope ( %) `�
Subregion (L r MLRA) _ Lat ! Long Datum�-
Sotl -Map Unit Nam e � w &c 1� l( wvx _ NWl- classification Are climatic / hydrologic conditions on the site typical,for this time of yeas? Yes No (If no, explain in Remarks -)
Are,Vegetation Soil , or Hydrology _ significantly disturbed? )Va Are "Normal Circumstances" present? Yes No -
Are Vegetation Sod or Hydrology naturally - problematic? A (1Pneeded, explain any answers in Remarks)
SUMMARY OF FINDINGS ­Attach site map,
nrlocations, transeciscl important features, exc
Hydrophyhc.VegetatiomPresent? Yes_ Na , Is,the Sampled Area
Hydnc Sod}Present? Yes NO;— ',within a'Wetland- Yes No
' Wetland,Hydroiogy Present? Yes �No
`Remarks
: ivhizhi oGY
`Wetland Hydrology Indicators
-
Secondary, Indicators (minurium of two�rgquired)
Primary Indicators (minimum of one is required check all that apply)
_ Surface Sod Cracks (136)
Surface Water (Al)
_ True Aquatic Plants (1314)
_ Sparsely, Vegetated Concave Surface (B8)
_
High Water =Table (A2)
_ Hydrogen Sulfide Odor (Cl)
_ Drainage Patterns (610)
Saturation (A3)
_ Oxidized Rhizospheres on Living Roots (C3)
_ Moss Trim Lines (1316)
_
Water Marks (81)
_'Presence of Reduced Iron (C4)
_ Dry- Season,Water Tatile (C2)
_
Sediment Deposits (132)
_ Recent Iron Reduction in Tilled Sods (C6)
_Crayfish Burrows (C8)
_
'Drift Deposits,(133)
_ Thin Muck Surface (C7)
_ Saturation Visible onrAerial Ima4ery.(C9)
_
Algal Mat,or,CrusNB4) -
_ Other (Explain In Remarks)
_ Stunted or Stressed Plants (D1)
_
Iron;Depostts (B5)
_ Geomorphic Position (D2)
_
inundation`Visible on Aenalsimagery
(137)
— Shallow Agwtard,(D3)
_
Water - Stained Leaves(B9)
_ Microtopographic Relief (154j r
_
— Aquatic Fauna (1313) ,
_ FAC- Neutral Test (D5) -
,Field Observ_ahons
Surface,Water Present?
Yes No Depth,(inches)
Water Table „Present?
Yes , No, ,Depth,(inches)
Yes No� "Depth,(inches) ,Wetland
Hydrology Present?- Yes"= No: ' -
Saturation Present?
'fnn
. _
(includes ca dla , e , - _
Descnbe Recorded'Data;,(stream gauge ,- monitoring well; aeha6photos, previous inspections),gf;available
Remarks
USyArmy'Corps of Engineers Eastern,Mountams and Piedmont - Version,2 0

VEGETATION (Four Strata) — UseFscientific names of plants.
Absolute Dominant
Tree Stratum (Plot size ) % Cover' Soecies?
2 i 10s, +1101, 5,0
4
-
6
Sampling Point rl,WA V4,
Number of Dominant Species r}
" That Are'OBL,,FACW, or FAC & (A),
7
Total % Cover of
= Total, Cover
50°/, f total cover ' 20% of total cover '
Sa hn /Shrub Stratum' (Plot,siz
�j 1
2 1 ter^
x2=
3
x3=
- - - -
x,4 =
5
x5=
6
r
a
I
m9f J'Total Cover
�s �
5t)% of iotal'cover -_ 20 %,of total,,cover
'Herb Stratum (Pibt,size -
1
2
3
-
5, - -
7
-
16
10
11 _ -
1 _ = ,TotailGover
h
50% of total'cover 20 %of total!cov_er __oL-
Woody Vine Stratum ,(Plot site
)
-
2
- -
_.........
3-
-
4
- -
5
Remarks
US Army Corps of Engmeeirs
= 'Total Cover
50% of total cover 20% of total'cover
on a> separate -sheet )
Total �Number,,of Dominant
Spebes,Ac�osswAll,Strata (B)r
' Percent of Dominant]Species
That Are OB it,,,FACW „or FAC (A/B)
Prevalence Index worksheet
Total % Cover of
Multiply by -
OBL specres
x 1 =
FACW species
x2=
FAC species
x3=
FACU species
x,4 =
UPL species
x5=
Column Totals
(A)
Prevalence Index -,B /A
—
11''- Rapid,Test for Hydrophytic;,Vegetation
N ii It
2 -,Dominance Testds ^ >50%
— n n II r
3z- Prevalence indexhs s3 0'
14 - Morphological Adaptations (Provide supporting,
,data in, Remarks'or�orna,separate sheet),
— Problems tic'Hydrophyticiveg'etation' (Ezpiam)
'Indicators of hydnc'sod and wetland,hydrologymust
be`present; unless disturbedlor problematic =
i r
Tree —Woody plants 'exciudmg`vines,'3'in (7 6,cm) or
more in diameter at`6reast height (DBH), regardless of`
height-
Sapling/Shrub - Woody plants; excluding vines;, less
than 3 m' DBH"and 'greater than or equa_ Ro,3 &A (f
'm) tall
r � :
Herb - All ; herbaceous r(non- woody)iplants, :regardless,
,of size andl,woody,,plants less than 3`28 6 tall—
All woody vines greater ttiani3- 28 fl�m
Hydrophytrc
Vegetation
Present? Yes No
u
`v
Eastern Mountains and `Piedmonts ,Versionx210-

SOIL �Samphng Point
Profile Description-- (Describe,to the depth needed to document ,the,indicator,orconfirm,the absence of indicators)
Depth Matrix
Redox Feature's
inches Color mo t) %r`
11ORK t 6 1W
Color, (moist) % Tvoe Loc
Texture Remarks -
fir-
i � e @ 4 100
- - —
'Type,, 6=(toncehfration, D=De letion, RM= Reduced,Matnx,dMS= Masked`Sand Grains _2 Location �,PL =Pore Lining, M= Matnz,
l
Hydric"Soil, indicators;
indicators ,fo'r,Probieinat)crHii ric'Sodsa
=- -
=� Histosbl (Al)
= Dark;Surface (S7)
= 2- cm,Muck;(A10)g(MLRA 14.7)_
=° „Hist�c Epipedori;(A2)
_ Polyvalue Below Surface (S8) (MLRAn147, 148) — CoastlPrame =Redox`(A16j
= °Black Hisbc (A3)
— Thin Dark'Surface (S9) (MLRA 147,148)
wm,
(MLRA 147, 148);,,
= ,Hytlroge9�5uifidet(A4)
—Loamy Gleyed,Matnx (F2)
— Piedmont Floodplam 96ds;(F19)
Stratified Layers(A5)
— Depleted,Matnx (0)
'(MLRA 1'36,'47) -
_ 2 cm,Muck (A10) (LRR N)
— Redox ,Dark Surface,(F6)
_ Very,Shailow Dark Surface (TF12)
— - Depleted;Beiow.Dark Surface (A11)
— Depleted, Dark Surface (F7),
— Other (Explain in Remarks)
t
Thick,Dark Surface (Al2) "
_ Redox Depressionsff8)
— Sandy Mucky Mineral (S1) (LRR N,
— Iron - Manganese Masses (F12) (LRR,N,
MLRA,147, 146)
MLRA 136)
-
_ `Sandy,Gleyed,Matnx (S4)
_ Umbnc Surface (F13) (MLRA =136, 122)
31ndicators of,hydrophytic vegetatiWand
— Sandy`Redox (S5)
— Piedmont'Floodplain�Soils (F19) (MLRA 148) wetland hydrology must be present,
_ Stripped,Matnx (S6)
_ Re&Pa�rent Material (F_21)�(MLRA 127, 147) unless disturbed or, problematic
Resthctirie Layer (if observed)
Type
�Depth,(mches)
Hydnc Sod Present? Yes No 1
Remarks
-
- -
t
i
i
i
US Army Gorps,of Engineers Eastern MouAtains and +P,ed`mont - Versiom2 0

WETLAND DETERMINATIOWDATA FORM- Eastern Mountafns,and,Piedmont Region
Project/Site HA"r"i/ City/County ( 5 Sampling Date '
AppiicanUOwner 4 ilai �@ i , !�@� e _ States SamplingiPoint �'fi f wic
investigators) " -- f,4 kN wr,, tt, i 7FNl t"jty 'Section, Township, Rarige _
Landform (hiilslope, terrace, etc a1 '( f >� o?� Local retie (concave onvex;,non�e)) _ _ Slope,( %)')`
,Subregion (LRR or,MLRA) _ Lai � � Long [r�' Datum Nt�
Sod Map Unit Name d ° ° I r00k,, -\ NWI classification ,
Are climatic / hydrologic conditions on the site typical, fonthis time of year? Yes No (If no; explain in Remarks )
Are Vegetation . Sod , or-Hydrology significantly disturbed? Cr Are "Normal Circumstances" present? Ye)� No
Are Vegetation, Sod or- Hydrology naturally problematic? ) (if needed „explain any answers in Remarks )
SUMMARWOF FINDINGS — Attach site map showing samp(ing,polnt locations, transects, Important features;-etc.
Hydrophytic Vegetation Present? Yes No
Is the Sampled Area
Hydric Soil Present? Yes -�,_-- -No withirn a Wetiandl Yes No
,Wedand,Hydrology Present? Yes No - t
Remarks - — - - -
HYDROLOGY
Wetland Hydrology Indicators I
-
Secondary Indicators (minimum ofdwoaquired),
'Pnmaii `,Indicators'(minimum'of 6n6'�is 'required. ^check
all,that appv) -
_ Surface5oil Cracks (136-)-
} Surface Water (A1)
_ True Aquatic,P6nts (614),
_'Sparsely4Vegetated Concave Surface (88j
y High Water,Table_ (A2)
_ .,Hyarogeh Sulfide�Odor (Cl)
_ Drainage Patterns,(B10)
Saturation (A3)
_ Oxidized ?Rhizospheres on Living Roots (C3),
_ Moss,Tnm, Lines +(1316)
Marks (pl)
_ Presence of Reduced Iron (C4)
_ Dry- Season Water. Table,(C2)
_Water
_ Sediment Deposits (62)
— „Recent Iron Reduction in Tilled Sods (C6)
_ Crayfish Burrows (CB)
_ Drift Deposits (133)
_'Thin Muck Surface,(C7)
_ Saturation Visible on Aerial Imagery (C9);
_ Algal Mat.or Crust,(134)
_ =Other (Ezplaimin Remarks)
_ Stunted or Stressed Plants (D1)
_ Iron Deposits,(85)
_ Geomorphic, Positron (132)
Inundation` Visible on Aenal'lmagery (137)
_ Shallow�Aquitard (D3)
,Water�,Staikd_Leaves (89)
_ Microtopographic Relief (D4),
,Aquae Faunas(613)
_ FAC- Neutral Test (D5)
FIeldi Observations.
-
i SurfaceWa'terP�resent?, Yes No,
Depth'(inches)
Water Table Present? Yes � No
Depthl(inches)
-
Saturation Present? Yes No
Depth.(inclies)
Wetland
Hydrology Present? Yes N_ o,
includes capillary fringe)
Describe Recorded Data (stream gauge,, monitoring, well, aerial photos, previous inspections) if available
Remarks
`t_JS Army Corps,of Engineers Eastern Mountains and Piedmont - Version 2 0

VEGETATIONa(Four Strata) — Use,scientificinames of plants.-
TrT Stratum (Plotisize i-'f ; i' V ) ',O/.-Cover- Species? S a
1 r 1 f V,bio i,
2 6_- D4-
Sampling Point J(7,4rj_
+nnmman�a�SQSf.wnricshoct- f ..
Number of Dominant Species
ThaYAre "OBL, FACW, or FAC
+Total,Number of Dominant
3 - - _ I, Species Across All Strata
4
5
6
7
�!= Total,Cov
50°�f,tgtal cover `7 C� 20% of total cover
Saohno /Shrub_Stratum (Plot size Ii 10c )
1
2
3
4
5
6-
7
8 _
9
_ =Total Cover
rr 50% of total cover 20% of total -cover
'Herb 'Stratum (Plot size
2
3
4
'8
9
10
11
= Total Cover
50 totaal'cover _ _ _ _ 20% of total cover
Woody Vine Stratum (Plot's i V-
2 LLO h I 4(A 47tsiC�i -r T_{
3
4
5 -°-
I ' =Total'Cove'r
50 %'of total cover '20% of,totai cover '
Remarks i(InGude photo numbers here or on.alseparate,sheet
Percent of Dommant'Species
Ttiat Are OBL, FACW, or�FAC
" (A)
Prevalence'Index worksheet
Total % Cover of
Mult oWbv
OBL species
x 1 = -
FACW species
x2=
FAC species
x3= _
FACU species
x4=1
UPL species
x5=
Column Totals
(A) (B)
Prevalence Index = BlA­
1 -Rapid Test for Hydrophytic Vegetation
]� 2 - Dominance Test is >50%
_ 3 - Prevalence Index is 53'0'
_ 4 - MorphologicalrAdaptations ';(Provide supporting,
data in Remarks or ona separate sheet)
_- Problematic Hydrophytic,Vegetation.' (Explain),
'Indicatorsiof
be present,,w
Tree - Woody plants,, excludmg,vines, 31in (7 -8 cm)lor
mowin diameter at Breast, height,(DBH),-regardiess,of
height
Sapling /Shrub- Woody;plants, excludmg-vines, less
than 3 in DBH and gieater thanior equal to 3 28,ft'(1
m) tall
Herb - All herbaceous (non - woody) plants, r-sgardiess
of size, and,woody,plants less,than 3 28 ft,tall,
Woody vi e - All woody vines,greater than 3'28 ft'm
height
Hydrophytic
Vegetation
Present? Yes No
US Army. Corps of Engineers Eastern Mountains and Piedmont - Version 2 0

.
Sampling Point-.
'Profile, Description,, (Describe to the depthE needed Lto-document,the iridicator,or.confirm,the absence'of indicators )
Depth° Matrix RedbicFeatures
inches - Color(moist) % " 'Colord(moist) '% Ty Loc Texture- _- Remarks
too
Sand Grains 'Location PL =Pore - Lining; M =Matnx
Hydhc,Soil'Indicators-
Indicators for Problematic Hydnc,Sods'.
= ,,iHistosol;(A1)
_ �Dark,Surfacer(W))
_ 2 cm fatu& (A10),(WRA 1471
Histic,Epipedon (A2)
_ P_oiyvaiue Below Surface (S8) (MLRA 147;148)
_,,Coast Prairie Redox (A16)
_ Black Histic (A3)
_ Thin Dark Surface (S9) (MLRA`147, 148)
(MLRA 147,148)
_ Hydrogen Sulfide (A4),
Stratified Layers,(A5)
Loamy Gleyed'Matnx,(F2)
Depleted Matrix (F3)
_ Piedmoni Fioodplain SOils,(F19)
(MLRA 136, 147)
_
2,cm Muck+(A10) (LRR,N)
_ Redox,Dark Surface (F6)
_ 'Very Shallow Dark Surface (TF12)
DepletediBeiow Dark Surface `(A11)
_ Depleted Dark Surface °(F7,)
i Other (Expiainjin Remarks)u
T6ick1Dark,Surface,(Al2)
_ Redox` Depressions (F8)
_ Santly'Mucky Mineral,(S1) (LRR N,
_ Iron = Manganese Masses (F12) (LRR N,
MLRA "147 „148),
MLRA 136)
_ sandyGleyed,Matnx (S4)
_ Umbne- Surface (F13) (MLRA 136,122)
'Indicators of hydrophytic vegetation and
Sandy' edok'(S5)
_ Piedmont Fioodpiain "Soils (F19) (MLRA 148)
wetland;hydrology,must be,present,
_ Stnpped[Matnx (S6}
_Red yParent.Material`(F21) (MLRA 127,147)
unless disturbed or,problemabc -
Restrictive Layer,(rf,observed)
Type
Depth (inches) Hydric Soil Present? Yes No
IN
�1
US Army Corps'of Engineers Eastern Mountains and, Piedmont - Version 2 0

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