20091051 Ver 1_Complete File_20091005

WA Michael F. Ea_9ley, Governor
Willimn G. Ross Jr., Sccretary
C!j North Carotina Departmcnt of Environment and Natural Rcsoarees
'Ua
Colleen Sullins, Director
Div ision of W atcr Quality
Stream Origin Determination
A.pplicant/O?vner's Name (corporation/individual who is legally responsible for the property and its compliance:
Applicant/OwnerAddress: 0 1_?l?1tif?C> CL14AUC\,' fQ_
Applicant's phone number; isa - 91--/(-/ - G Fax number: ---,_. _
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Applicant's email address: Uj4_ r e 71eiC o eV7 eCiv7 Ce t, ?)op K.i e 61 YA f 16U . C tlN?
Consultant/Contact person Name (if applicable):
Consultant address (if applicable;):
Consultant's phone number:
Consultant's email address:
Fax nurnber:
Name of Project: r3 v L ? ? t Q 70 2?zL?L i C1 f County. l7 l i r.1
Nearest Named stream + River Basin. (.froth USGS topographic map):
Ut_ - i_,
Please provide a brief description of this project (attach site plan if available):
CC,v 14.1
Please attach a map (if site location indicating project boundaries using US+GS 1:24,000 topo map and NRC:S county soil survey.
Location of project site - please include reference to the county, nearest named town and highway number:
?/ n p
z WC T
Has any DWQ staff visited the site? if yes, please provide DiWQ staff name,
Vrsrt:
and date of
This form may be submitted via entail (chris.pullinger a,ncmai] new faxed (252946-921.5), mailed or hand-delivered to:
943 Wash:iogtot.l Square Mall, Washington, NC 27889. (Note: Submittals of the review packages on Friday after .12:90 pm will
he stamped as received on the next business day).
Please contact Chris Pullinger at 252-948-3920 if you have any questions regarding this form.
North Carolina Division of Water Quality Intemet: h2o.enr.statexcus
943 Washington Square Mall Phone: [phone]
Wash ington,NC27989 FAX [phone]
An Equal OpporturitylA rrmative Action Employer- 50% Recycledt90% Post Consumer Paper
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Scan 4.JP9

Scan 4.jpg
r a 'WAR In Wdmm 1%
NC nX%'0 Stream Identification Form Version 4.11
Date: 77 , ProjecVSite: Latitude: r7 f
Evaluator- f. County: Longitude:
Total Points: Stream Determination (circle one) Other
stream ?s at +ens ;•,'e treat Ephemeral Intermittent Perennial &g. Duad Name: PPrf
if
a e -
A. Geamor holo (Subtotal = ) Absent Weak Moderate Strong
to Continuity of channel bed and bank 0 1 2 3
2. Sinuosity of channel along thalweg 0 1 2 3
_-T-In-channel structure' ex riffle-pool; step-pool,
ripple-pool sequence 0 1 2 3
4. Particle size of stream substrate 0 1 2 3
5. Active/relict floodplain 0 1 2 3
? _
6- Depositional bars or benches 0 1 2 3
7. Recent alluvial deposits 0 1 2 3
8. Headcuts 0 1 2 3
9. Grade control Q 0.5 1 1 5
10 Natural valley 0 05 1 1.5
1 1 . Second or greater order channel No = 0 Yes = 3
artificial ditches are not rated, see discussions in manual
R t--irlrnln 1C11htnla1 =
12. Presence of Baseflow 0 1 2 3
13. Iron oxidizing bacteria 0 1 2 3
14. Leaf litter 1.5 1 05 0
15. Sediment on plants or debris 0 05 1 1 5
16 Organic debris fines or piles 0 Q.5 1 1.5
17 Soil-based evidence of high water table'? No = 0 Yes = 3
r, R Ir n 1e h+ t?1 =
18 Fibrous roots in streambed 3 2 1 0
19. Rooted upland plants in streambed 3 2 1 0
20. Macrobenthos (note diversity and abundance) 0 1 2 3
21 Aquatic Moliusks 0 1 2 3
22. Fish 0 0.5 1 1.5
23. Crayftsh 0 05 1 1 5
24 Amphibians 0 0.5 1 1 5
25. Algae 0 0.5 1 1 5
26 Wetland plants in streambed FACVV = 0 75, OBL = 1.5 Other = 0
perennial streams may also be identified using other methods. Seep 35 of manual.
Notes.

Sketch'