U-5169 (3)

ENVIRONMENTAL SERVICES INC
9401 C Southern Pine Boulevard
Charlotte NC 28273
Phone [phone] * Fax [phone]
wwv♦ environmentalserucesmc com
18 July 2012
Mr Andrew Williams � co US Army Corps of Engineers Raleigh Regulatory Field Office
3331 Heritage Trade Drive Suite 105
Wake Forest North Carolina 27587
RE Jurisdictional Determination Request
U 5169 — US 311 (I 74) / NC 68 Interchange Ramp Improvement Project
Guilford County, North Carolina
Dear Mr Williams
o�
sr��p�jF�ry
R
H
Enclosed please find one (1) copy of the following items to be included in the Jurisdictional
Determination Package for the U 5169 US 311 (I 74) / NC 68 Interchange Ramp Improvement project
• Figure 1 — Vicinity Map
• Figure 2 — Study Area Map
• Figure 3 — Jurisdictional Features Map
• NCDWQ Stream Identification Forms
• USACE Stream Quality Assessment Worksheets
• USACE Wetland Determination Data Forms
• NCDWQ Wetland Rating Worksheets
• Approved Jurisdictional Determination Forms
This information has also been e mailed to you in PDF format Should you have any questions or require
any additional information please contact me at 704 523 7225
Sincerely
ENVIRONMENTAL SERVICES INC
:5. 7Petitgout S Pul
Vice President
Enclosures
Copy Ms Amy Euliss — NCDWQ
Ms Anne Redmond — HNTB
FLORIDA GEORGIA NORTH CAROLINA MARYLAND OHIO

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Q Project Boundary
c
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GUILFORD 6
Miles RANDO PL N
0
Source. Primary Roads, municipalities and
Interstate Highways provided by NCDOT, • _ o Trinity 311
Hydrology provided by Basin Pro; 0. _ "New Market
Disclaimer The information depicted on this figure is for
informational purposes only and was not prepared for and is B J Q O ° DRAFT
not suitable for legal or engineering purposes. _ p A
rrk0`H °xr'� -,aoy Project: ER10500.00
Vicinity Map
(• �� US 311 (1 -74) / NC 68 Interchange Ramp Improvement Project Date: July 2012
`= c' Guilford County, North Carolina Drwn /Chkd: KT /JB
fh f,3
S.T.I.P. No. U -5169 Figure. 1
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*Location and extent is approximate.
1000 2000
Feet
Source USGS Digital Raster Graphic, High
Point East (1999), High Point West (1999),
Guilford (1991) and Kernersville (1981), NC
Quadrangles; Project boundary approximated
by ES1.
r
Disclaimer: The information depicted on this flgur. N for
informational purpose, only and was not prepared
not suitable for legal or engineering purposes.
r
0, 'OlrtM C9p Study Area Map Project: ER10500.00
US 311 (1-74) NC 68 Interchange Ramp Improvement Project Date: July 2012
Guilford County, North Carolina Drwn/Chkd: KT/J B
S.T.I.P. No. U-5169 Figure: 2
P:1GeoGraTrojectskERI0500,00�MSllocation.dgn. 11104/10,3:30 PM

SA
NC Division of Water Quality — Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v 4 0
NC DWQ Stream Identification Form Version 4 0
Date 1()(2,16110
ProjectlSite N C 6g ( v5 31
Latitude
Evaluator E51 5 6end-ol`,
County (�„��d
Longitude W
Total Points
Stream is at least Intermittent Z 6
Stream Determination (circle one)
nterm ltten Perennial
Other
e g Quad Name V Vi 14C
if z 19 or perennial if 2 30
2 Sinuosity of channel along thalweg
0
A Geomorphology (Subtotal = 4 S 1
Absent
Weak
Moderate
Strong
1 Continuity of channel bed and bank
0
1
2 )
3
2 Sinuosity of channel along thalweg
0
1
2
3
3 In channel structure ex riffle pool step pool
ripple sequence
p
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
00
3
7 Recent alluvial deposits
0
1
2
3
8 Headcuts
0
1
2
3
9 Grade control
0
05
1
1 5
10 Natural valley
0
0 5
CD
1 5
11 Second or greater order channel
No = 0
Yes = 3
artificial ditches are not rated see discussions In manual _
B Hydrology (Subtotal= 6 S )
12 Presence of Baseflow
0
1
2
3
13 Iron oxidizing bacteria
0
1
2
3
14 Leaf litter
15
1
05
0
15 Sediment on plants or debris
0
5
1
1 5
16 Organic debris lines or piles
0
05
1
1 5
17 Soil based evidence of high water table?
No = 0
Yes = 3
G L3101ogy (Subtotal = _ 5
18 Fibrous roots in streambed
3
2
1
0
19 Rooted plants In streambed
3
2
1
0
20 Macrobenthos (note diversity and abundance)
0
1
2
3
21 Aquatic Mollusks
1
2
3
22 Fish
00
05
1
15
23 Crayfish
0
05
1
15
24 Amphibians
0
05
1
1 5
25 Algae
0
05
1
1 5
26 Wetland plants in streambed
FAC = 0 5
FACW = 0 75 OBL = 1 5
Other = 0
perennial streams may also be identified using other methods Seep 34 of manual
Notes Cv4kva ova r d n 15o r4 rekck
c co 5A
S
Sketch
40

Mr
NC Division of Water Quality — Methodology for Identification of intermittent and
Perennial Streams and Their Oriains v 4 0
NC DWQ Stream Identification Form Version 4 0
Date 1 0 26 o
ProjectfSite N( ( , g VS 31
Latitude N 15 9 `915 0
Evaluator Gs �Qen%r1
County 61,11�,,j
Longitude W 393
Total Points
Stream is at least Intermittent Z6
Stream De ermination (circle one)
Intermittent Perennial
Other
eg Quad Name PoiA F,5�
If a 19 or perennial If _ 30
2 Sinuosity of channel along thalweg
0
A Geomorphology Subtotal = lL5 )
Absent
Weak
Moderate
Strong
1 Continuity of channel bed and bank
0
1
2
3
2 Sinuosity of channel along thalweg
0
1
W
3
3 In channel structure ex nffle pool step -pool
ripple pool sequence
0
1
Q)
3
4 Particle size of stream substrate
0
1
2
3
5 Active /relict floodplain
0
1
3
6 Depositional bars or benches
0
1
2
3
7 Recent alluvial deposits
0
1
2
3
8 Headcuts
0
1
05
3
9 Grade control
0 5
1
1 5
10 Natural valley
0
1
15
11 Second or greater order channel
IN = 0
Yes = 3
artificial ditches are not rated see discussions in manual
B Hydrology Subtotal =
12 Presence of Baseflow
0
1
2
3
13 Iron oxidizing bacteria
1
2
3
14 Leaf litter
EA_
1
05
0
15 Sediment on plants or debris
0
(0-9
1
15
16 Organic debris lines or piles
0
05
1
1 5
17 Soil based evidence of high water table?
No = 0
Yes = 3
C Biology (Subtotal = 5 ' ) —
18 Fibrous roots in streambed
3
2
1
0
19 Rooted plants in streambed
3
1
0
20 Macrobenthos (note diversity and abundance)
0
1
2
3
21 Aquatic Mollusks
CO)
1
2
3
22 Fish
0
05
1
15
23 Crayfish
0
05
1
15
24 Amphibians
CO)
05
1
1 5
25 Algae
0
0
1
1 5
26 Wetland plants in streambed
FAC = 0 5
FACW = 0 75
OBL = 1 5 Other = 0
perennial streams may also be identified using other methods See p 34 of manual
Notes EykIvajoa rjnej on SO T+
frach v 5r1 r
SO
SZ
Sketch
40

SL
1%W nWn C +ream Manfifirafinn lPnrm VPreinn d 11
Date 6 j2$ 2
Project/Site N(- ( US C
Latitude % v 03l q nJ
Evaluator Sy S%anion
County 6 VI(,Td
Longitude 911til w
Total Points
Stream is at least intermittent ��
Stream Determination (circl
Other (wl �rLi
d2:19 or perennial if z 30
Ephemeral Intermitten erennial
e g Quad Name
A Geomorphology (Subtotal = 5
Absent
Weak
Moderate
Strong
1 Continuity of channel bed and bank
0
1
2
3
2 Sinuosity of channel along thalweg
0
1
2
3
3 In- channel structure ex riffle -pool step -pool
ripple-pool se uence
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
1 5
1
2
3
9 Grade control
0
05
1
15
10 Natural valley
0
perennial streams may also be identified using other methods See p 35 of manual
1
15
11 Second or greater order channel
(No= 0
Yes = 3
° artificial ditches are not rated see discussions in manual
R Hvrirnlnnv (Suhtntal = 10 1
12 Presence of Baseflow
0
1
2
3
13 Iron oxidizing bacteria
0
1
2
3
14 Leaf litter
15
1
05
0
15 Sediment on plants or debris
0
0 5
1
15
16 Organic debris lines or piles
0
05
1
15
17 Soil based evidence of high water table'?
No = 0
(Yes: 3
(' Rinlnnv lCnhtn4nl = ', l
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)
1
2
3
21 Aquatic Mollusks
1
2
3
22 Fish
05
1
15
23 Crayfish
0
05
1
15
24 Amphibians
0
05
1
1 5
25 Algae
0
05
1
1 5
26 Wetland plants in streambed
FACW = 0 75 OBL = 1 5
Other = 0
perennial streams may also be identified using other methods See p 35 of manual
Notes r ( r-6 on SO f e I
Sketch

USACE AID# DWQ # Site # (indicate on attached map)
FE-31 _ i
STREAM QUALITY ASSESSMENT WORKSHEET Ski
Provide the following information for the stream reach under assessment
1 Applicant s name NC-901- 2 Evaluator s name
3 Date of evaluation % (o
5 Name of stream VT +t, We A- J�,r K DuI2 91VC C
7 Approximate drainage area ac_rc 5
9 Length of reach evaluated SO '
11 Site coordinates (if known) prefer in decimal degrees
4 Time of evaluation O b
6 River basm COkoe- Fea(
8 Stream order 5 �
10 County &W t (�r d
12 Subdivision name (if any) N(6
Latitude (ex 34 872312) N D O S Longitude (ex —77 556611)
Method location determined (circle) GPS Topo Shee Ortho (Aerial) Photo /GIS Other GIS Other
13 Location of reach under evaluation (note roads and landmarks and attach map identifying stream(s) location)
Nc, I PJ
14 Proposed channel work (if any)
15 Recent weather conditions A»roXimAW4 I (IU1, 4 prec p fad --iovl wtH,,r {ray 2!f hr >,
16 Site conditions attune of visit WGkk eto,,,/ e)1+re. -,uh eJ fiat anne- I
17 Identify any special waterway classifications known _Section 10 _Tidal Waters !Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters _ Nutrient Sensitive Waters _Water Supply Watershed >—((I IV)
18 Is there a pond or lake located upstream of the evaluation pomt9 YES NO If yes estimate the water surface area
19 Does channel appear on USGS quad map? YES NO 20 Does channel appear on USDA Soil Survey? YES NO
21 Estimated watershed land use 2% Residential ZO % Commercial _% Industrial _% Agricultural
1 b % Forested _% Cleared / Logged _% Other ( )
22 Bankfull width 2 13 23 Bank height (from bed to top of bank)
M
24 Channel slope down center of stream K Flat (0 to 2 %) _Gentle (2 to 4 %) _Moderate (4 to 10 %) _Steep ( >10 %)
25 Channel sinuosity Straight Occasional bends Frequent meander _Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2) Begin by determining the most appropriate ecoregion based on
location teriam vegetation stream classification etc Every characteristic must be scored using the same ecoregion Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet Scores should reflect an overall assessment of the stream reach under evaluation If a
characteristic cannot be evaluated due to site or weather conditions enter 0 in the scoring box and provide an explanation in the
comment section Where there are obvious changes in the character of a stream under review (e g the stream flows from a pasture
into a forest) the stream may be divided into smaller reaches that display more continuity and a separate form used to evaluate each
reach The total score assigned to a stream reach must range between 0 and 100 with a score of 100 representing a stream of the
highest quality
Total Score (from reverse) 93 Comments 5Q3 j 5
Evaluator's Signature S / J Date_°_t?-,. I I o
This channel evaluation fo6i& ed to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement Form subject to change — version 06/03 To Comment, please call 919 876 8441 x 26

STREAM QUALITY ASSESSMENT WORKSHEET
* These charactenstics are not assessed m coastal streams
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USACE AID#
DWQ
Site # (indicate on attached map)
FES STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment
1 Applicant s name NC Poi"
3 Date of evaluation J of 2 (, (l o
5 Name of stream VT 4- wa l Gr K tzeps �.y,
7 Approximate drainage area 15 nc�c5
9 Length of reach evaluated a ¢�
11 Site coordinates (if known) prefer in decimal degrees
Evaluator s name F 5. - 5-GG,+o r)
4 Time of evaluation H o L)
6 River basin Cape, 1'egd
8 Stream order 54-
10 County (D g f for
12 Subdivision name (if any) N/ A
Lahtude (ex 34 872312) N 39 q11'50 Longitude (ex —77 556611) W -41 4 3 513
Method location determined (circle) GPS opo Shee Ortho (Aenal) Photo/GIS Other GIS Other
13 Location of reach under evaluation (note ear y roads and landmarks and attach map identifying stream(s) location)
N (, 6% 4 `(orK Av G
14 Proposed channel work (if any) N (fl
15 Recent weather conditions Awr, or, 1 k( , 1 to (4, p( ( tr i J Ai on W111 I f a a$
16 Site conditions at time of visit W t,t k flow - U, ° n ri c
17 Identify any special waterway classifications known _Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters _ Nutrient Sensitive Waters Water Supply Watershed -.>—<(I IV)
18 Is there a pond or lake located upstream of the evaluation point? YES NO If yes estimate the water surface area
19 Does channel appear on USGS quad map? YES N )
21 Estimated watershed land use 2a % Residential
Forested
22 Bankfull width 3 l
20 Does channel appear on USDA Soil Survey? YES NO
1% Commercial _% Industrial _% Agricultural
_% Cleared / Logged _% Other ( )
23 Bank height (from bed to top of bank) Z 5
24 Channel slope down center of stream Flat (0 to 2 %) _Gentle (2 to 4 %) Moderate (4 to 10 %) _Steep (>10%)
25 Channel sinuosity Straight Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2) Begin by determining the most appropriate ecoregion based on
location, terrain vegetation stream classification, etc Every characteristic must be scored using the same ecoregion Assign points
to each characteristic within the range shown for the ecoregion Page 3 provides a brief description of how to review the
characteristics identified in the worksheet Scores should reflect an overall assessment of the stream reach under evaluation If a
characteristic cannot be evaluated due to site or weather conditions enter 0 in the scoring box and provide an explanation in the
comment section Where there are obvious changes in the character of a stream under review (e g the stream flows from a pasture
into a forest) the stream may be divided into smaller reaches that display more continuity and a separate form used to evaluate each
reach The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality
Total Score (from reverse) 5 b Comments SQA ) !S
Evaluator's Signature Date loll(, 11 a
This channel evaluation fo t to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement Form subject to change — version 06/03 To Comment, please call 919 876 8441 x 26

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed m coastal streams
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USACE AID# DWQ # Site # (indicate on attached map)
Q STREAM QUALITY ASSESSMENT WORKSHEET -AQ,
Provide the following information for the stream reach under assessment
1 Applicants name N 0-r
3 Date of evaluation
5 Name of stream VT io Wes}^ �-orl- Nc,2 z r"
7 Approximate drainage area 30 acre i
9 Length of reach evaluated 50 4:4-
11 Site coordinates (if known) prefer in decimal degrees
2 Evaluator s name F-5-T - 3(,'cniba'1
4 Time of evaluation 4 00
6 River basin L p s- Fe a ('
8 Stream order s�
10 County (p A fl r A
12 Subdivision name (if any) N .(Ifi
Latitude (ex 34 872312) 3(O 005, Li N Longitude (ex —77 556611) �l 41 4 1s W
Method location determined (circle) GPS Topo Shect Ortho (Aenal) Photo /GIS Other GIS Other
13 Location of reach under evaluation (note nearby roads and an ark attach map identifying stream(s) location)
Foam- Of- Tmywr,A ©s and KP, Dr. ci n4r{�, o� K�r 2tl�t i L Ileac i445ec+ aA nF Ne. G8 yS 311
14 Proposed channel work (if any) N
15 Recent weather conditions Cpl e-CO- n 0 ere U pi- g+10oA
t�r� p AS t 4 � b r s
16 Site conditions at rime of visit WLAr, 0
0"annc )
17 Identify any special waterway classifications known
_Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters _
Nutrient Sensitive Waters _Water Supply Watershed (I IV)
18 Is there a pond or lake located upstream of the evaluation point? YES NO yes estimate the water surface area
19 Does channel appear on USGS quad map? YES NO
20 Does channel appear on USDA Soil Survey? YES NO
21 Estimated watershed land use � 0 % Residential
_% Commercial _% Industrial _% Agricultural
I 0 % Forested
_% Cleared / Logged to % Other ( r0a85 % iMO «viovS )
22 Bankfull width L�" 4��
23 Bank height (from bed to top of bank) 2' S TT
24 Channel slope down center of stream )< Flat (0 to 2 %)
_Gentle (2 to 4 %) _Moderate (4 to 10 %) _Steep ( >10 %)
25 Channel sinuosity Straight _Occasional bends X, Frequent meander _Very sinuous _Braided channel
Instructions for completion of worksheet (located on page 2) Begin by determining the most appropriate ecoregion based on
location terrain vegetation stream classification etc Every characteristic must be scored using the same ecoregion Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet Scores should reflect an overall assessment of the stream reach under evaluation If a
characteristic cannot be evaluated due to site or weather conditions enter 0 in the scoring box and provide an explanation in the
comment section Where there are obvious changes in the character of a stream under review (e g the stream flows from a pasture
into a forest) the stream may be divided into smaller reaches that display more continuity and a separate form used to evaluate each
reach The total score assigned to a stream reach must range between 0 and 100 with a score of 100 representing a stream of the
highest quality
Total Score (from reverse) ��' Comments SQ>< , S C.
Evaluator's Signature ! / &4-L, Date_ _ ��1 Z.
This channel evaluation fo a ed to be used only as a guide to assist landowners and environmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement Form subject to change - version 06/03 To Comment please call 919 876 8441 x 26

STREAM QUALITY ASSESSMENT WORKSHEET
11,1110
�� ; �� vx �`
C GTERIST CSMN
TCOREGTON POINT#
3 �
�oastal ` „Piedmont.
GE5h&
Mountamg
N V
O���
M
ti
k Pi esence of flow / persistent pools in stream
0-5
0 - 4
0-5
no flow or saturation = 0 strong flow = max points)
;fir 2
,P Evidence of past human alteration
k extensive alteration = 0 no alteration = max oints
0-6
0 - 5
0-5
3
3
A"e Riparian zone
0- 6
0- 4
0- 5
3
s r
no buffer = 0, contiguous, wide buffer = max points)
” �4
4 S Erdence of nutrient or chemical discharges
0 5
0- 4
0- 4
2
P,4
ri extensive dischar es = 0 no discharges = max points)
S 5
� ,' -Groundwater discharge
0-3
0-4
0-4
2-
�r
no dischar e = 0' rm s ,Fsee s wetlands etc = max points)
6`
, r} Presence of adjacent floodplam
0-4
0-4
0-2
Z
' no floo lam = 0 extensive flood lam = max omts
r �� i Entrenchment ( floodplam access
p- 5�
0- 4
0- 2
3
� c
dee I entrenched = 0 frequent flooding = max points)
8 +��
Presence of adjacent wetlands a }
` 0-6
0 - 4
0-2
j
�ti r
no wetlands = 0 lar a adjacent wetlands = max points)
9L4-'
f Channel sinuosity
4
F O - S3
-0-4
0-3+
3
f extensive cha nehzaho =0 natural meander= max points)
fi
10
` x i ; Sediment Input
0-5
0 - 4
0-4
3
extensive deposition-- 0, orno sediment = max points)
117
Size &Fdiversity'of channel bed substrates
0-4
0 - 5
3
m t fine homo onus = 0 lar a diverse sizes = max omts
2
_, ,.Evidence of channel incision or widening
0 -,5
0- 4
0- 5
3
3 dee l incised''= 0 stable bed & banks = max omts
j
13
w ` -.,,,Presence ofamajor bank failures
0-5,
0 - 5
�A 0-5
3
w
severe erosion � 0 no erosion stable banks = max omts
14
t-4 F ' Co Root depth and dense on banks
max
0 -t3
0-4
0 -5
2
no v sibleToots£=x0 dense-roots throughout = points) }
Impact liyf agnculture, F livestock, or timber production
W 0 - 5 '
0-4
0 - 5
f substantial impact =0 no evidence = max points)
16�
+� , `P,ires ice of riffle -p f llnpple -pool complexes 4
0- 3
0-5
0-6
3
f no Jiffies %n les or ools = 0 well developed = max omts
X17
�: -k } z� �,kt'41 44 Habitat complexity
0 -' 6
0-6
0 - 6
7j
.P
tittle or no Mitat = 0 fre went =vaned habitats = max
points)f
18
coverage tj
�' � nano bed
� 0� _ 5�
0-5
0 - 5
o skad- fve�etat on &ntmuous max oints
J
3
9,iW�
Substrate embeddedness?
0- 4
0- 4
3
t k1 Y de 1 embedded = 0 loose structure = max
tPresence�of,stream invertebrates (see page 4) 4
tFS�,
0 -4
0 -5
0 -5
I
20
z� �� -
,k t no evidence = 0 ,common numerous es = max points)
, F f f
21
5'F ,¢resence of amphibians ;
0-4
0 - 4
0-4
no'evidence = 0commo numerous es =max points)
O'
221
v Y ti a Presence of
0-4
0-4
o-4
p
no evidence -= 0 common numerous types = max points)
X23 f�
14 1013 Of, t —, Evidence of wildlife use
0-6
0 - 5
0-5
Z
no evidence = 0 abundant evidence - max points)
ota omts ossi 1 1 0 100 00
O CORE als h V ����°n
*_These characteristics are not assessed in coastal streams

wA „p
WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont
- r
Project/Site A) C 65 � U5 31) Pw14erri)on9 , City/County 1+15bVO) 4 I���%rd Sampling Date c� Z I�
Applicant/Owner C t) r'L State Sampling Point GO Of
Investigator(s) fST- '5-$e1r4vf\ Section Township Range _ V48
Landform (hilislope terrace etc) h () 5( eet- Local relief (concave convex none) (.-n v e x Slope(/) 2 _Irg
Subregion(LRRorMLRA) 5 /+Numb( Let 36 00410 N Long 79 9155 W Datum W('3 t
Soil Map Unit Name W I l f( S NWI classification Nt A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes -/-, No (If no explain In Remarks)
Are Vegetation Soil or Hydrology significantly disturbed? Are Normal Circumstances present? Yes No
Are Vegetation Soil or Hydrology naturally problematic? (If needed explain any answers in Remarks )
SUMMARY OF FINDINGS — Attach site map showing sampling point locations transects important features, etc
Hydrophytic Vegetation Present? Yes i< No Is the Sampled Area
Hydric Soil Present? Yes No within a Wetland? Yes No
Wetland Hydrology Present? Yes No
DQ+1 e°tn" - 1 ,
HYDROLOGY
nyf -) - `.r158 d, "nql
Wetland Hydrology Indicators
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required, check all that apply)
_ Surface Soil Cracks (136)
— Surface Water (Al)
_ True Aquatic Plants (B14)
_ Sparsely Vegetated Concave Surface (B8)
_ High Water Table (A2)
_ Hydrogen Sulfide Odor (C1)
_ Drainage Patterns (B10)
_ Saturation (A3)
_ Oxidized Rhizospheres on Living Roots (C3)
_ Moss Trim Lines (B16)
— Water Marks (B1)
_ Presence of Reduced Iron (C4)
_ Dry Season Water Table (C2)
_ Sediment Deposits (B2)
_ Recent Iron Reduction In Tilled Soils (C6)
_ Crayfish Burrows (C8)
_ Drift Deposits (B3)
_ Thin Muck Surface (C7)
_ Saturation Visible on Aerial Imagery (C9)
— Algal Mal or Crust (B4)
_ Other (Explain In Remarks)
_ Stunted or Stressed Plants (Dl)
_ Iron Deposits (B5)
_ Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (B7)
_ Shallow Aquitard (D3)
_ Water Stained Leaves (B9)
_ Microtopographic Relief (D4)
_ Aquatic Fauna (B13)
_ FAGNeutral Test (D5)
Field Observations
Surface Water Present? Yes
No )< Depth (Inches)
Water Table Present? Yes
No Depth (inches)
Saturation Present? Yes _
No Depth (inches) 712
Wetland Hydrology Present? Yes No X_
ncludes ca ilia fringe)
Describe Recorded Data (stream gauge monitoring well aerial photos previous inspections) If available
Remarks
the h �drai��ic.
Cri'�°�rro ✓� has ri"t- bc�� Me�°-
US Army Corps of Engineers Eastern Mountains and Piedmont- Interim Version

WA vP
VEGETATION (Four Strata) — Use scientific names of plants Sampling Point as VP
Herb Stratum (Plot size 0 f—+ )
1 Fr�°�u t A Virh If) 1gfig
2.
9 5
72
Absolute
Dominant Indicator
Dominance Test worksheet:
Tree Stratum (Plot size
A Cover
Species? Status
Number of Dominant Species ZZ
1
8
That Are OBL FACW or FAC J (A)
2
8
Total Number of Dominant 3
3
10
Species Across All Strata (B)
4
12
00
or
5
z�
30
=Total Cover
— FAC
3
That Are 0131- FACW FAC (A/B)
8
5
8
Prevalence Index worksheet
7
=Total Cover
Total °/ Cover of Multiply by
8
0131. species 0 x 1= O
= Total Cover
SaolinolShrub
Stratum (Plot size a �
)
FACW species 0 x2= O
1
Li v8 amhAr } wnrfJ
(S
A) FAC f
FAC species S5 x3= Z!;S
FACU species 1_ x4= 10
2 L, r i o&, -%Aron +vl 240-rrn 7-0 rAG
3
Svnfe, r-5 Vir'!trnr,onot
10
T
Al fAC
UPL species O x5= O
Column Totals 9 S (A) 2-q'5 (B)
Prevalence Index = BIA = 3 I
4
5
8
Hydrophytic Vegetation Indicators
7
1 Rapid Test for Hydrophytic Vegetation
8
_
2 Dominance Test Is >50 h
90
3 Prevalence Index is 5i 0'
_
t
Herb Stratum (Plot size 0 f—+ )
1 Fr�°�u t A Virh If) 1gfig
2.
9 5
72
= Total Cover
_ PAC
3
4
5
8
7
8
9
10
11
12
Woody Vine Stratum (Plot size ( 0 )
1 CPrrk )ckgonir-\
2
z�
30
=Total Cover
— FAC
3
4
5
8
39
=Total Cover
Remarks (Include photo numbers here or on a separate sheet)
Tic Kt4roph,4rc. veyi-,44,n cn {eri1,1 hti5 be,.\ rnr4-
/ullailYWna A r .05 rcdc-
_ 4 Morphological Adaptations (Provide supporting
data In Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soli and wetland hydrology must
be present unless disturbed or problematic
Tree — Woody plants excluding vines 3 in (I 8 cm) or
more in diameter at breast height (DBH) regardless of
helghL
SaplinglShrub — Woody plants excluding vines less
than 31n DBH and greater than 3 28 It (1 m) tall
Herb — AII herbaceous (non woody) plants regardless
of size and woody plants less than 3 28 ft tall
Woody vine —AII woody vines greater than 3 28 ft in
height
Hydrophytic
Vegetation
Present? Yes X_ No
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version

wq
SOIL
Sampling Point
Profile Description (Describe to the depth needed to document the Indicator or confirm the absence of Indicators )
Depth Matrix Redox Features
(Inchesl Color (moist) D_ Color (moist) 0/ Tyoe La pp Texture Remarks
0- 0o, ON
'rype C =Concentration D =De lotion RM= Reduced Matrix MS= Masked Sand Grains 'Location F
Hydnc Soil Indicators
indicators for Problematic Hydric Soils'
_ Histosol (Al)
_ Dark Surface (S7)
_ 2 cm Muck (Al 0) (MLRA 147)
_ Histic Epipedon (A2)
_ Polyvalua Below Surface (S8) (MLRA 147 148)
_ Coast Prairie Redox (A16)
— Black Histic (A3)
_ Thin Dark Surface (S9) (MLRA 147 148)
(MLRA 147 148)
_ Hydrogen Sulfide (A4)
_ Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Soils (F19)
_ Stratified Layers (A5)
_ Depleted Matrix (P3)
(MLRA 136 147)
_ 2 cm Muck (Al 0) (LRR N)
_ Redox Dark Surface (F6)
— Red Parent Material (72)
_ Depleted Below Dark Surface (Al 1)
_ Depleted Dark Surface (177)
_ Very Shallow Dark Surface (TF12)
_ Thick Dark Surface (Al2)
_ Redox Depressions (FB)
_ Other (Explain in Remarks)
_ Sandy Mucky Mineral (S1) (LRR N
— Iron Manganese Masses (F12) (LRR N
MLRA 147 148)
MLRA 136)
_ Sandy Gleyed Matrix (S4)
___, Umbric Surface (F13) (MLRA 136 122)
'Indicators of hydrophytic vegetation and
_ Sandy Redox (S5)
— Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present
_ Stripped Mabix (S6) unless disturbed or problematic
Restrictive Layer (if observed)
Hy
Type
Depth (Inches) dric Soil Present? Yes No
Remarks (( r
Unconl- I,AgkcA (0nc�5tc+C
1 c. h (df 1 c- Sat 1 C" ter t h A- 6e,, tytf {-
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version

WA wcA
WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont
Project/site NL (61 I V5 3 11 Xo,4,rc imu (. CIWCounty wi0� - 6u11fof J Sampling Date 10 1 zG o
Applicent/Owner _ NG9oT State N Sampling Point aoU W1
Investigator(s) tr.sT- :51,e4oy-\ Section Township Range N/A
Landform (hillslope terrace etc ) _ h 1(5( ec, Local relief (concave convex none) Coll f K —Slope(/) 21
Subregion (LRR or MLRA) S Ai( n {l L Let 3 00 �y o N Long -79 91 st `) vp/ Datum W (95 S tl�
Soil Map Unit Name _W It Kd S NWI classification NIA
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no explain In Remarks )
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances present? Yes X_ No
Are Vegetabon Soil or Hydrology naturally problematic? (If needed explain any answers in Remarks )
SUMMARY OF FINDINGS - Attach site map showing sampling point locations transacts important features etc
Hydrophytic Vegetation Present? Yes K No is the Sampled Area
Hydric Sol[ Present? Yes X No within a Wetland? Yes �_ No
Wetland Hydrology Present? Yes K No
D- A-% �ar�rk i,, j`'rr5� ->1k
HYDROLOGY
Wetland Hydrology Indicators
Secondary Indicators (minimum of two recuired)
Primary Indicators (minimum of one is reouired check
all that aooly)
_ Surface Soil Cracks (136)
_ Surface Water (Al) _
True Aquatic Plants (1314)
_ Sparsely Vegetated Concave Surface (88)
_ High WaterTable (A2) _
Hydrogen Sulfide Odor (Cl)
_„ Drainage Patterns (B10)
Saturation (A3) _
Oxidized Rhizospheres on Living Roots (C3)
_ Moss Trim Lines (B16)
_ Water Marks (81) _
Presence of Reduced Iron (C4)
_ Dry Season Water Table (C2)
_ Sediment Deposits (B2) _
Recent Iron Reduction in Tilled Soils (C6)
` Crayfish Burrows (C8)
_ Drift Deposits (133) _
Thin Muck Surface (C7)
_ Saturation Visible on Aerial Imagery (C9)
_ Algal Mat or Crust (134) —
Other (Explain in Remarks)
_ Stunted or Stressed Plants (D1)
_ Iron Deposits (B5)
_ Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (B7)
_ Shallow Aquitard (D3)
_ Water Stained Leaves (B9)
_ Microtopographic Relief (D4)
_ Aquatic Fauna (1313)
_ FAC Neutral Test (DS)
Field Observations
Surface Water Present? Yes No
Depth (inches)T
Water Table Present? Yes X No
Depth (inches) T
Saturation Present? Yes No
Depth (inches) 5 r{ac t`.
Wetland Hydrology Present? Yes No
nciudes capillary fringe)
Describe Recorded Data (stream gauge monitoring well aerial photos previous Inspections) If available
Remarks
4- hyd ofo3lr_ Cr14Cri v\
65 6ce{1 mr-i
US Army Corps of Engineers Eastern Mountains and Piedmont— Interim Version

VEGETATION (Four Strata) — Use scientific names of plants
0 Absolute Dominant indicator
I
Tree Stratum (Plot size F ) Cover Soecles? Status
1 SaIIyC iii rH �_ _ 0P-L,
2
3
4
5
6
WA wL%
Sampling Point 03 we{-
Number of Dominant Species
That Are OBL FACW or FAC (A)
Total Number of Dominant
Species Across All Strata f (B)
Percent of Dominant Species
That Are OBL FACW or FAC 100 (A18)
7
Prevalence Index worksheet
Total 9' Cover of Multiply by
0 x 1 = 0
OBL species 2 2
8
2,0 Total Cover
Saollno /Shrub Stratum (Plot size ) �+ )
FACW species 0 x2= O
1 wr3 yam. ti✓ 5� A ��°\
h
10
i
�� rn�
FAC species D x 3= 7(
P �
FACU species �� 40 40 x4 =�_
UPL species 0 X5= 0_
Column Totals 100 (A) 2-'7 0— (B)
2 I.,rlo�£ r.Trt '1v
il�A �fa\
3 r_ ib� ARtr -,rI 4a,1y\ its N CU f
4
5
Prevalence Index = B/A = z
6
Hydrophytic Vegetation Indicators
7
1 Rapid Test for Hydrophytic Vegetation
8
2 Dominance Test is >50 /
9
9
✓
p 3 Prevalence Index is 53 01
t
r q — - Total Cover
Herb Stratum (Plot size t o T" 4-- )
1 Lojou i4 V1 100411 �o
2
3
4
5
6
7
8
9
10
11
12
AC -
=Total Cover
Woody Vine Stratum (Plot size ) { ¢ )
1 L „cirri .�1� n °j�c ra Z� FAC
2
3
4
5
6
Zo - Total Cover
—4 Morphological Adaptations (Provide supporting
data In Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetation (Explain)
'Indicators of hyddc soli and wetland hydrology must
be present, unless disturbed or problematic
Definitions of Four Vegetation Strata
Tree - Woody plants excluding vines 3 in (7 6 cm) or
more In diameter at breast height (DBH) regardless of
height
Sapling /Shrub - Woody plants excluding vines less
than 31n DBH and greater than 3 28 It (1 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 greater than 3 28 ft In
height
Hydrophytic
Vegetation
Present? Yes X No
narks (Include photo numbers here or on a separate sheet )
-,C hyJr0fl,(4 C VC3r-+mAjD✓1 C_ft4v ft ,N he5 6Ecr\ Mr
US Army Corps of Engineers Eastern Mountains and Piedmont- Interim Version

WA we
SOIL Sampling Point aG 3 we l
Profile Description (Describe to the depth needed to document the Indicator or confirm the absence of Indicators }
Depth Matrix
Redox Features
(inches) Colo (moist)_L_
Color (moist) _A Type�Loc�—
Texture Remarks
It
s 14-
'Type C =Concentration D =De Ie0on RM= Reduced Matrix MS= Masked Sand Grains
'Location PL =Pore Lining M =Matrix
Hydric Sall Indicators
Indicators for Problematic Hydric Solis'
_ Histosol (Al)
_ Dark Surface (S7)
_ 2 cm Muck (A10) (MLRA 147)
_ Histic Epipedon (A2)
_ Polyvalue Below Surface (S8) (MLRA 147 148) _ Coast Prairie Redox (A16)
_ Black Histic (A3)
_ Thin Dark Surface (S9) (MLRA 147 148)
(MLRA 147 148)
_ Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (F2)
_ Piedmont Floodplaln Soils (F19)
— Stratified Layers (A5)
Depleted Matrix (173)
(MLRA 136 147)
_ 2 cm Muck (A10) (LRR N)
— Redox Dark Surface (F6)
_ Red Parent Material (72)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
^ Very Shallow Dark Surface (TF12)
_ Thick Dark Surface (Al2)
_ Redox Depressions (F8)
_, Other (Explain in Remarks)
_ Sandy Mucky Mineral (S1) (LRR N
_ Iron Manganese Masses (F12) (LRR N
MLRA 147 148)
MLRA 136)
_ Sandy Gleyed Matrix (S4)
— Umbdc Surface (F13) (MLRA 136 122)
'Indicators of hydrophytic vegetation and
_ Sandy Redox (S5)
_ Piedmont Floodplaln Soils (1719) (MLRA 148) wetland hydrology must be present
_ Stripped Matrix (S6)
unless disturbed or problematic
Restrictive Layer (If observed)
Type
[Hydric
Depth (Inches)
Sol[ Present? Yes _� No
I',e- h /Aric S041 cr'l4cfrv, k-5 b(e , (i p- –
US Army Corps of Engineers Eastern Mountains and Piedmont– Interim Version

w 6 .,e
WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont
ProjecUSrts NC-6i I J , 3l l Si'ti-cr'vhan ►�¢ city /camty %{t��h �`��`���t� rc� Sampling Date 6 Z f Z-
Applicant/Owner NO &T State _ ! Sampling Point �
Investigators) L-511- 389,4-are Section Township Range N18
Landfomr (hillsiope terrace etc) h r1151W, Kcal relief (concave convex none) C.Dn C&V Q. Slope (Y r �l
Subregion (LRR or MLRA) Mt-RAB61 LOP UOP Let 59 003 b `f N Long '-I j 1153 z- W Datum W 5 3 tf
Soil Map Unit Name W IIKcS - P;,M 10',}er ` NWI classification N(A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes _�< No (if no explain in Remarks)
Are Vegetation . Soil . or Hydrology significantly disturbed? Are' Normal Circumstances present? Yes —y— No
Are Vegetation Soil . or Hydrology naturally problematic? (If needed explain any answers In Remarks)
SUMMARY OF FINDINGS - Attach site map showing sampling point locations transects important features etc
Hydrophytic Vegetation Present? Yes K No Is the Sampled Area
Hyddc Soil Present? Yes No X within a Wetland? Yes No ><
Weiland Hydrology Present? Yes No
Remarks
(tarn - J„n 5&G�1v''1ol `
HYDROLOGY
Wetland Hydrology Indicators
Secondary Indicators (minimum of two recuined)
Primary Indicators (minimum of one is reouired.
check all that apply)
_ Surface Soil Cracks (B6)
_ Surface Water (A1)
_ True Aquatic Plants (814)
_ Sparsely Vegetated Concave Surface (88)
_ High Water Table (A2)
_ Hydrogen Sulfide Odor (C1)
_ Drainage Pattems (B10)
_ Saturation (A3)
_ Oxidized Rhtmspheres on Living Roots (C3) _ Moss Trim Lines (B16)
_ Water Marks (B1)
_ Presence of Reduced Iron (C4)
_ Dry - Season Water Table (C2)
_ Sediment Deposits (B2)
_ Record Iron Reduction in Tilled Sous (C6)
_ Crayfish Burrows (C8)
_ Drift Deposits (83)
_, Thin Muck Surface (C7)
_ Saturation Visible on Aerial imagery (C9)
_ Algal Mat or Crust (B4)
_ Other (Explain in Remarks)
_ Stunted or Stressed Plants (D1)
_ Iron Deposits (85)
_ Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (B7)
_ Shallow Aquitord (D3)
_ Water Stained Leaves (89)
_ Microtopographlc Relief (D4)
_ Aquatic Faurra (813)
_ FAGNeutral Test (135)
Field Observations
Surface Water Present? Yes _
No Depth (inches)
Water Table Present? Yes
No Depth (Inches)
Saturation Present? Yes _
No Depth (Inches)
Wetland Hydrology Present? Yes No K
(Includes capillary fringe)
Describe Recorded Data (stream gauge monitoring well aerial photos previous inspections) if available
Remarks
—jht- {�.jdroloy L Crr +orlon has na± G�ee,�
rnei-
US Army Corps of Engineers
Eastern Mountains and Piedmont- Interim Version

VEGETATION (Four Strata) - Use scientific names of plants
Q Absolute Domtna
Sampling Point aT It
Tree Stratum (Plot size /� )
1 (Sig �rcNS a� b
Cover Species? Status
Zo
Number of Dominant Species
That Are OBL FACW or FAC
2.
r
LI JlcisM Ct/ �jT* 1 AGtT�U
_
ZA F/t�
/S b S u (Plot stze ( 5
3
� rl ac(� nd�av l �v 11 p 1 0.
�— �_
Total
Species Across Dominant Strata
Species Across All Strata
J 5 _ _� F�
r
2 A(e C ( U64 -v^1 __�_
3 yirwooknoN �_ _E4 CJ
4
Percent of Dominant Species
5
6
That Are OBL FACW or FAC
6
7
Hydrophytle Vegetation Indicators
Prevalence Index worksheet
(A)
(B)
56 /0 (AIB)
8
Vine Stratum (Plot size �7 0
7< Cz en p radicant
-Mes 5 � �can5
0 = Total Cover
)
30 _ FAC
_�-
Total % Cover of: Multiply bv.
OBL species x 1 =
= Total Cover
S�p�ln
/S b S u (Plot stze ( 5
_
)
FACW species x2=
1
Go rn �) (ol i
J 5 _ _� F�
FAC species x3=
FACU species x4=
UPL species x5=
2 A(e C ( U64 -v^1 __�_
3 yirwooknoN �_ _E4 CJ
4
Column Totals (A) (B)
Prevalence index = B/A =
5
6
Hydrophytle Vegetation Indicators
7
1 Rapid Test for Hydrophytic Vegetation
8
i< 2 Dominance Test is >50%
s
3 Prevalence Index Is 53 0'
10
_
Herb Stratum (Plot size )
1
2
3
4
5
6
7
8.
9
10
11
12.
`� = Total Cover — 4 Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soli and wetland hydrology must
be present, unless disturbed or problematic
Definitions of Four Vegetation Strata.
Tree - Woody plants excluding vines 3 In (7 6 em) or
more In dlameterat breast height (DBH) regardless of
height.
Sapling/Shrub- Woody plants excluding vines less
than 3 in DBH and greater than 3 28 it (1 m) tall
Herb -All herbaceous (non - woody) plants regardless
of size and woody plants less than 328 ft tall
Woo
1 T
z. C
Vine Stratum (Plot size �7 0
7< Cz en p radicant
-Mes 5 � �can5
0 = Total Cover
)
30 _ FAC
_�-
Woody vine -All woody vines greater than 3.28 ft in
height
Hydrophytic
Vegetation
Present? Yes )< No
3 Heiler -e he tb< 1 o
4
5
6
= Total Cover
or on a separate sheet)
11,L
US Army Corps of Engineers Eastern Mountains and Piedmont - Interim Version

SOIL
Sampling Point Q F It
-
Profile Description (Describe to the depth needed to document the indicator or confirm the absence of indicators )
Depth Matrix Redox Features
(Inches) Color o st Color (moist) %_ Twe Lo Texture Remarks
'Tore Concentration. D= DeDletlon. RM= Reduced Matrix. MS= Masked Sand Grains 'Location PL =Pore lining, M--Matrix
Hydric Soll Indicators
indicators for Problematic Hydric Soils'
_ Hlstosol (Al)
_ Dark Surface (S7)
_ 2 cm Muds (At 0) (MLRA 147)
_ Histic Eplpedon (A2)
_ Polyvalue Below Surface (S8) (MLRA 147 148)
_ Coast Prairie Redox (A16)
_ Black Histic (A3)
_ Thin Dark Surface (S9) (MLRA 147 148)
(MLRA 147 148)
_ Hydrogen Sulfide (A4)
_ Loamy Gieyed Mal* (F2)
_ Piedmont Floodplaln Soils (1719)
_ Stratified Layers (A5)
_ Depleted Matrix (P3)
(MLRA 136 147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (176)
_ Red Parent Material M)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (177)
_ Very Shallow Dark Surface (rF12)
_ Thick Dark Surface (Al2)
_ Redox Depresslons (F8)
_ Other (Explain in Remarks)
_ Sandy Mucky Mineral (S1) (LRR N
_ Iron - Manganese Masses (F12) (LRR N
MLRA 147 148)
MLRA 136)
_ Sandy Gleyed Matrix (S4]
_ Umbnc Surface (F13) (MLRA 136 122)
' Indlcators of hydrophyhc vegetation and
_ Sandy Redox (S5)
_ Piedmont Floodplain Soils (F19) (MLRA 148)
welland hydrology must be present,
_ Stripped Matrix (S6)
unless disturbed or problematic.
Type
Depth Qnches)
Hydric Soil Present? Yea No -,
I A e- kjtart c 5-,, 1 �.T ( L` rt a'� 4 0.S Fl, b't~,
US Army Corps of Engineers Eastern Mountains and Piedmont - Interim Version

wa Wei
WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont
{
Pro)ecd/Site N�-6B �V5 s(1 L- n{�G�an�C., CUylCounry, }4j5 P0,At jbVI1;f k Sampling Date Z$ 2
Appflcant/Owner C NLD or 2 State N C, Sampling Point a
Investigators) YS—T - S8eW40 1 Section Township Range iJtA
Landform (hifislope terrace etc.) N.Jplw -) Local relief (concave convex none) CO nC-'at Slope (A) IL--
Subregion (LRRorMLRA)49A (, ILARP Lot 36 Qa361 N Long -TI 9°1531 v�1 Datum
CC" - Wyrr, {' L ^� i
5011 Map Unit Name W i � K�-5 - � ��� F Qi ��C NWI classification �I i- rn wed
Are climatic/ hydrologic conditions on the site typical for this tune of year? Yes X_ No (If no explain in Remarks.)
Are Vegetation . Soil . or Hydrology significantly disturbed? Are "Normal Circumstances present? Yes No
Are Vegetation . Soll . or Hydrology naturally problematic? (If needed explain any answers in Remarks)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations transects important features etc
Hydrophydc Vegetation Present? Yes No Is the Sampled Area No
Hyddc Soil Present? Yes within a Wetland? Yes K _ No
Wetland Hydrology Present? Yes T No
Remarks
D�� Pork i5 J�hsdtc.�vn�. �
HYDROLOGY
US Army Corps of Engineers Eastern Mountains and Piedmont - interim Version
Wetland Hydrology Indicators Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required check all that aooly) _ Surface Soil Cracks (136)
_ Surface Water (Al) _ True Aquatic Plants (B14) _ Sparsely Vegetated Concave Surface (BB)
High Water Table (A2) _ Hydrogen Sulfide Odor (C1) _ Drainage Patterns (810)
Saturation (A3) _ Oxidized Rhtzospheres on Living Roots (0) _ Moss Trim Lines (B16)
_ Water Marks (131) _ Presence of Reduced Iron (C4) _ Dry- Season Water Table (C2)
_ Sediment Deposits (B2) _ Recent Iron Reduction in Tilled Soils (C6) _ Crayfish Burrows (CB)
_ Drift Deposits (93) _ Thin Muck Surface (C7) _ Saturation Visible on Aerial imagery (C9)
_ Algal Mat or Crust (84) _ Other (Explain In Remarks) _ Stunted or Stressed Plants (Di)
_ Iron Deposits (135) _ Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (137) _ Shallow Aquitard (D3)
_ Water Stained Leaves (B9) _ Microlopogrephic Relief (D4)
_ Aquatic Fauna (1313) _ FAC- Neutral Test (135)
Field Observations
Surface Water Present? Yes No X_ Depth (inches)
Water Table Present? Yes No_ Depth (Inches) �4t_
_x`
Saturation Present? Yes No Depth (Inches)
Wetland Hydrology Present? Yes _< No
includes capillary fringe)
Describe Recorded Data (stream gauge monitoring well aerial photos previous inspections) If available
Remarks
beep
US Army Corps of Engineers Eastern Mountains and Piedmont - interim Version

8
G
Qf
VEGETATION
(Four Strata) — Use scientific
names of plants
Sampling Point
B
30
Absolute Dominant Indicator
Dominance Test worksheet:
Tree
(Plot size )
% Cover cles Status
Number of Dominant Species
1
rfi cr:r- rvbrv-,
3 0 ` A--
That Are OBL FACW or FAC (A)
4
5
g
D = Total Cover
1
S�1iw` f,�
�4
Total Numbers Dominant
3
�����
Species Across All Strata (B)
I 4
Percent of Dominant Scies
5
O FAC
That Are L FACW or
s
7
Prevalence Index worksheet:
8
Total % Cover of: Multiply by,
�
60 = Total Cover
OBL species x 1 =
Saplina/Shrub Stratum (Plot size �
)
FACW species x2=
1
Ace-C F-br )
113 1 _ FA-C
FAC species x3=
2
RV 4_rrA a A-(k
06L
FACU species x4=
3
L- vt 4Aryy-r f 14,0,
_ N
UPL species x5=
4
Column Totals (A) (B)
I 5
Prevalence index = BiA =
8
Hydrophytic Vegetation Indicators
_ 1 Rapid Test for Hydrophytic Vegetation
8
2 Dominance Test Is >50%
g
3 Prevalence Index is s3 0'
10
4 Morphological Adaptations' (Provide supporting
S
=Total Cover
—
data in Remarks or on a separate sheet)
Herb
Stratum (Plot size )
Problematic Hydrophytic Vegetation' (Explain)
1
t 2
'indicators of hydrlc soil and wetland hydrology must
3
be present, unless disturbed or problematic
4
Definitions of Four Vegetation Strata
5
8
Tree — Woody plants excluding vines 3 in Q 8 cm) or
more in diameter at breast height (DBH) regardless of
height
SapiingBhrub —Woody plants excluding vines less
than 3 In DBH and greater than 3 28 It (1 m) tali
Herb —All herbeceeue (non - woody) plants regerdle s
of she and woody plants less than 3.213 it tall.
Woody vine —All woody vines greater than 3 28 It in
height
7
B
g
10
11
12.
Woody
1
2
V e Stra (Plot size 30
.Xlr,,. C[-jr0" (_G aC-
)
So
=Total Cover
y eA'(-_
Hydrophytic
Vegetation
Present? Yes No
2 am r ACMI 3 0 _
3 5,AJ f?�vnc�l �rh �_ fj
.1(
4
5
g
D = Total Cover
or on a separate
The- h jdro9kyitic, VcDeAw ,I ,n cxi4crwn ha.) Seem me
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version
i
i
1
i
r
t
i

SOIL
Sampling Point.
Profile Description (Describe to the depth needed to document the indicator or confirm the absence of Indicators)
Depth Matrix Redox Features
(inches) Colo (moist) %_ Color (m fall A Tvoe Lo Texture Remarks
0-4' Zs DSIM�/
4 - l t+ -Z—S � ,�,� -- } 5 � L S�AA -1 Clay tog',
C=Concentrat(on D=De IeOon RM= Reduced Matnx MS =Masked Sand Grains 'Location PL =Pore UnIng M= Matrix
Hydric Soil Indicators
Indicators for Problematic Hydric Soils'
_ Histosol (Al)
_ Dark Surface (S7)
_ 2 cm Muck (A10) (MLRA 147)
_ Histic Epipedon (A2)
_ Polyvalue Below Surface (S6) (MLRA 147 148)
_ Coast Prairie Redox (A16)
_ Black Hisfic (A3)
_ Thin Dark Surface (S9) (MLRA 147 148)
(MLRA 147 148)
_ Hydrogen Sulfide (A4)
_ Loamy Gleyed Matrix (F2)
_ Piedmont Roodplain Soils (F19)
_ Stratified Layers (A5)
Depleted Matrix (P3)
(MLRA 136 147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
_ Red Parent Material (72)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
_ Very Shallow Dark Surface (fF12)
_ Thick Dark Surface (Al2)
_ Redox Depressions (Ffi)
_ Other (Explain in Remarks)
_ Sandy Mucky Mineral (S7) (LRR N
_ Iron Manganese Masses (F12) (LRR N
MLRA 147 146)
MLRA 136)
_ Sandy Gleyed Matrix (S4)
_ Umbdc Surface (F13) (MLRA 136 122)
3Indicators of hydrophybc vegetabon and
_ Sandy Redox (S5)
_ Piedmont Floodplaln Soils (F19) (MLRA 148)
wetland hydrology must be present,
_ Stripped Matrix (S6)
unless disturbed or problematic
Restrictive Layer (if observed)
Type
Depth Qnches)
HydricSofi Present? Yes, _ No
-r,i-\G h7d rl C 50 I I u I+erl 0-n h.L S . ee"A /1,%4
US Amry Corps of Engineers Eastern Mountains and Piedmont— Interim Version

wC V
WETLAND DETERMINATION DATA FORM — Eastern Mountains rand
1 Piedmont
Projecusits. NC b$ y , 3 ( I T- +c� v )ame z city /County rfl'Ah P��4 1 O I f Ord Sampling Date 6O Z ( 2'
Applicant/Owner NL 9a`(` State A►C- Sampling Point
investigatudq F5Z" �tJcn+oYO Section Township Range A/(
Landfomn (hiilslope terrace etc) h'115100L Local relief (concave convex none)
Submgion (tRR or MLRA) I fi ( RIP Leh 17(- Ud3b S N Long 11 9 1157 l VA/ /Datum W6
Soil Map Unit Name NWIclassification N�r
Are climatic / hydrologic conditions on the site typical for this time of year? Yes i< No Of no explain in Remarks.)
Are Vegetation . Soil . or Hydrology significantly disturbed? Are "Normal Circumstances present? Yes X No
Are Vegetation . Sod . or Hydrology naturally problematic? (tf needed explain any answers in Remarks)
SUMMARY OF FINDINGS - Attach site map showing sampling point locations transacts important features etc
Hydrophybc Vegetation Present? Yes K No is the Sampled Area
Hydro Soil Present? Yes No _) within a Wetland? Yes No ><
Wetland Hydrology Present? Yes No--2L-
Remarks
DAB Q'rn`�' I J (tail- JvflSc�tG���'
HYDROLOGY
US Army Caps of Engineers Eastern Mountains and Piedmont— Interim Version
Wetland Hydrology indicators Secondary Indicators (minimum of two required)
Primary Indicators fmh*num of one rs required, check all that apply) _ Surface Soil Cracks (B6)
_ Surface Water (Al) _ True Aquatic Plants (B14) _ Sparsely Vegetated Concave Surface (138)
_ High WatarTable (A2) _ Hydrogen Sulfide Odor (Cl) _ Drainage Patterns (B10)
_ Saturation (A3) _ Oxidized Rhizospheres on Living Roots (0) _ Moss Trim Lines (BI 6)
_ Water (Marks (B1) _ Presence of Reduced Iron (C4) _ Dry - Season Water Table (C2)
_ Sediment Deposits (1212) _ Recent Iron Reduction in Tilled Soils (36) _ Crayfish Burrows (C8)
_ Drift Deposits (63) _ Thin Muck Surface (C7) _ Saturation Visible on Asnal Imagery (C9)
_ Algal Mat or Gust (64) _ Other (Explain In Remarks) _ Stunted or Stressed Plants (131)
_ Iron Deposits (B5) _ Geomorphic Position (D2)
_ Inundation Visible on Asdal imagery (B7) _ Shallow Aquilard (D3)
_ Water Stained Leaves (B9) _ Microtopographlc Relief (D4)
_ Aquatic Fauna (013) _ FAGNeutrat Test (05)
Field Observations
Surface Water Present? Yes _ No X Depth (Inches)
Water Table Present? Yes^ No ) Depth (inches)
Satumbon Present? Yes _ No �_ Depth (Inches)
Wettand Hydrology Present? Yes No K
includes capillary fringe)
Describe Recorded Data (stream gauge monitoring well aerial photos previous inspections) tf avallable:
Remarks
7h,- K, /Jroloy c, Cli�non hyS nod G�eer� me�-
US Army Caps of Engineers Eastern Mountains and Piedmont— Interim Version

VEGETATION (Four Strata) - Use scientific names of plants Sampling Point c 1pl
8
3
Absolute Dominant Indicator
Dominance Test worksheet
=Total Cover
Tres Stratum (Plot `size )
over Species? Status
Number of Dominant Spades
t
1
� 4.-"4 rrt9`�S�
30 �F
That Are OBL FACW or FAC
Total Number of Dominant
J (A)
eh.,�. �
Z (X, cr fd 30 r , C j
' FAC
3
n
2. \/,W-5 1704vnk,16 Ir.. 5 L
Species Across Ali Strata
(B)
4
6
2,0 = Total Cover
Percent of Dominant Species
r /D
Hydrophytie Vegetation Indicators
5
That Are OBL FACW or FAC
+� (AIB)
6
6
2 Dominance Test is >50%
g
7
. _ 3 Prevalence Index is 53 0'
Prevalence index worksheet
8
,� Tole( Cover
Herb Stratum (Plot size )
1
4 Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetaton � (Fain)
'Indicators of hydric soil and wetland hydrology must
be present unless disturbed or problematic
Total in Cover Of: Multiply by.
OBL species x1=
=Total Cover
Se tin Shrub Stratum (Plot size )
Definitions of Four Vegetation Strata
Tree — Woody plants excluding vines 3 in (7 6 cm) or
more in diameter at breast height (DBH) regardless of
height
SapOnglShrub —Woody plants excluding vines less
than 3 in DBH and greater than 3 28 It (1 m) tall
Herb —Ali herbaceous (non - woody) plants regardless
of size and woody plants lass than 3.28 It taL
Woody vine —All woody vines greater than 3 28 ft in
height.
5
FACW species x2=
1 L-t h-A -,A r-4A
Zp
_ C
FAC species x3-
FACU species x4=
UPL species x5=
Column Totals (A) (B)
Prevalence Index = B/A =
2 &J "J-5 N. 6- 1 S
_{�V
3 or(tJS (Dn F V J
4 :-r1 Rfd j V 1 r Ir) o.n FAW
5 Gana, -ivmF 1 Sa. N V Pt--
2. \/,W-5 1704vnk,16 Ir.. 5 L
6
4
5
6
2,0 = Total Cover
Remarks (include photo numbers here or on a separate sheet)
Hydrophytie Vegetation Indicators
7
_ 1 Rapid Test for Hydrophyttc Vegetation
6
2 Dominance Test is >50%
g
. _ 3 Prevalence Index is 53 0'
10
-'Pt.t. hyaroFk,, (-
US Army Corps of Engineers Eastern Mountains and Piedmont— Interim Version
r
i
t
I
,
,I
i
i
,
,� Tole( Cover
Herb Stratum (Plot size )
1
4 Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetaton � (Fain)
'Indicators of hydric soil and wetland hydrology must
be present unless disturbed or problematic
2.
3
4
Definitions of Four Vegetation Strata
Tree — Woody plants excluding vines 3 in (7 6 cm) or
more in diameter at breast height (DBH) regardless of
height
SapOnglShrub —Woody plants excluding vines less
than 3 in DBH and greater than 3 28 It (1 m) tall
Herb —Ali herbaceous (non - woody) plants regardless
of size and woody plants lass than 3.28 It taL
Woody vine —All woody vines greater than 3 28 ft in
height.
5
6
7
8
9
10
11
12
O = Total Cover
Woody Vine SICAM (Plot size )
1 OKtC . &Q--r i7'
Hydrophytic
Vegetation
Present? Yes No —
2. \/,W-5 1704vnk,16 Ir.. 5 L
3
4
5
6
2,0 = Total Cover
Remarks (include photo numbers here or on a separate sheet)
-'Pt.t. hyaroFk,, (-
US Army Corps of Engineers Eastern Mountains and Piedmont— Interim Version
r
i
t
I
,
,I
i
i
,

SOIL
Sampling Polnt QJ 2—
Profile Description (Describe to the depth needed to document the Indicator or confirm the absence of Indicators)
Depth Matrix Redox Features
Qnches) Color (Moist) A_ Color (moist) _ Twe Loc Texture Remarks
0—It 2- 5i /Lt �odM
►r� °Ibt 2�— ,�
Hydric Soil Indicators
Indicators for Problematic Hydric Solis'
_ Histosol (A1)
_ Dark Surface (S7)
_ 2 c n Muck (AiD) (MLRA 147)
_ Hisdc Epipedon (A2)
_ Polyvalue Below Surface (S8) (MLRA 147 148)
_ Coast Praine Redox (A16)
_ Black Histic (A3)
_ Thin Dark Surface (S9) (MLRA 147 148)
(MLRA 147 148)
_ Hydrogen Sulfide (A4)
_ Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Solis (Fig)
_ Stratified Layers (A5)
_ Depleted Matrix (F3)
(MLRA 136 147)
_ 2 cm Muck (Al 0) (LRR N)
_ Redox Dark Surface (F6)
_ Red Parent Material (TF2)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
_ Very Shallow Dark Surface (fF12)
_ Thick Dark Surface (Al2)
_ Redox Depressions (F8)
_ Other (Explain In Remarks)
_ Sandy Mucky Mineral (Si) (LRR N
_ Iron- Manganese Masses (1`12) (LRR N
MLRA 147 148)
MLRA 138)
_ Sandy Gleyed Matrix (S4)
_ Umbric Surface (F13) (MLRA 136 122)
'Indicators of hydmphytic vegetation and
_ Sandy Redox (S5)
_, Piedmont Floodplain Soils (F19) (MLRA 148)
wedend hydrology must be present,
_ Stripped Matnx (S8)
unless disturbed or pmblemaDc
Type
Depth (Inches)
Hydric Soil Present? Yes No
14c kIS-ric 5-,1 ( C,r(�er��r. k5 kmt Se,,,7 mu--�-
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version

W L wc4-
r
WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont
Project/Site ri(- 64 ( US >[ 1 5-A+< diartwLr City/County fth PolAW)VI&Ct SampMgData Zg 2
AppllcantlOwner , NCD or State N (I Sampling Point GtD Z
c 1
investigators) F-51- - 56er40rl Section Township Range t4f A
Landfomt (hllislope terrace etc) kQAA wg+e r Local relief (concave convex none Co ncAv t✓ Slope ( /e) 2'�0
Subregion (-RR or MLRA) AVA No LR P Let 116 00a'(-'S N Long 115 1 VJ Datum W&5 z 97
SoilMepUnitName W11Keg - NnJ' -K{ - r'�Yn��'#' C ep e>� NWlclassi5callon
,
Ara climatic/ hydrologic conditions on the site typical for this time of year? Yes _ Z-_ No (If no explain in Remarks )
Are Vegetation . Soil . or Hydrology significantly disturbed? Are 'Normal Circumstances present? Yes No
Are Vegetation . Soil . or Hydrology naturally problematic? (if needed explain any answers in Remarks)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations transects important features etc
Hydrophytic Vegetation Present? Yes No Is the Sampled Area
Hydric Soil Present? Yes —� No within a Wetland? Yes K _ No
Wetland Hydrology Present? Yes No
Remarks
HYDROLOGY
US Army Corps of Engineers Eastern Mountains and Piedmont- Interim Version
Weiland Hydrology indicators Secondary Indicators (minimum of two reouiredl
Primary Indicators (minimum of one is reauired check all that apply) _ Surface Soft Cracks (86)
_ Surface Water (Al) _ True Aquatic Plants C31 4) _ Sparsely Vegetated Concave Surface (Be)
High Water Table (A2) _ Hydrogen Sulfide Odor (Cl) _, Drainage Patterns (B70)
Saturation (A3) _ Oxidized Rhtzospheres on Living Roots (C3) _ Moss Trim Lines (B16)
_ Water Marks (B1) _ Presence of Reduced Iron (C4) _ Dry - Season Water Table (C2)
_ Sediment Deposits (B2) _ Recent Iron Reductlon In Tilled Solis (C6) _ Crayfish Burrows (C8)
_ Drift Deposits (B3) _ Thin Muck Surface (C7) _ Saturation Visible on Aerial Imagery (C9)
_ Algal Mat or Crust (B4) _ Other (Explain In Remarks) _ Stunted or Stressed Plants (D1)
_ Iron Deposits (B5) _ Geomorphic Positron (132)
_ Inundation Visible on Aerial Imagery (87) _ Shallow Aquitard (D3)
_ Water Stained Leaves (Bg) _ Mlcrotopographic Relief (134)
_ Aquatic Fauna (B13) _ FAG- Neutrel Test (135)
Field Observabons
Surface Water Present? Yes— No x Depth (inches)
Water Table Present? Yes *_ No_ Depth 6 r
(inches)
Saturation Present? Yes X No_ Depth (inches) 10 r
Wetland Hydrology Present? Yes No
nciudes capillary fdn e
Describe Recorded Data (stream gauge monitoring well aerial photos previous Inspections) if available
Remarks
US Army Corps of Engineers Eastern Mountains and Piedmont- Interim Version

i
VEGETATION
(Four Strata) — Use scientific
names of
plants
Sampling Point Q01
Definitions of Four Vegetabon Strata
Tree — Woody ptanffi excluding vines 3 In (7 6 cm) or
more in diameter at breast height (DBH) regardless of
height
Sapling/Shrub —Woody plants excluding vines less
than 3 in D13H and greater than 3 28 ft (1 m) tail
Herb —Ali herbaceous (non - woody) plants regardless
of size and woody plants less than 3.28 ft tall
Woody vine —Ail woody vines greater than 3 28 ft in
height
Tree (Plot size 3 )
Stratu
1 G,_( r,,6ry,
Absolute Dominant Indicator
Cover Species? tahis
2T
Dominance Test worksheet
Number of Dominant Species
That Are 0131. FACW or FAC (A)
B
2.
� w+1 `J v �
L!
�-, �
— =
Total Number of Dominant
Species Across All Strata_ (B)
3 54 4 X R 2­0 �_
4
5
.+-C / S OC(A CAIMI- 5
�%
�rO4��L'�"���
� Fhcyj
6
Percent of Dominant Spades
That Are OBL FACW or FAC /� (A/B)
5
hy)
7
Prevalence Index worksheet:
Total % Cover of Multiply by.
OBL species x 1=
FACW species x 2 =
FAC species x3=
FACUspades x4=
8
= Total Cover
Sealino/Shrub Stratum (Plot sae IS )
1 LI�,t�pMbA� 5--jr C, We \_ IS J r—
2. yrilp�uS Vt(t�14,�t<r1� 5 Tom/ 9ACV
3
�X1or gerinflIv4ni
V✓
UPL species x5=
4
_r
Column Totals (A) (B)
5
Prevalence Index = B/A =
6
Hydrophytic Vegetation Indicators
_ 1 Rapid Test for Hydrophybc Vegetation
2 Dominance Test Is >50%
8
_ 3 Prevalence Index Is 53 0' '
10
i
Z5 = Tote) Cover
Herb Stratum (Plot size. �)
1
_ 4 Morphological Adaptations (Provide supporting
data in Remarks or on a separate sheet)
Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hyddc soli and wetiarM hydrdogy must
be present unless disturbed or problematic
2
3
4
Definitions of Four Vegetabon Strata
Tree — Woody ptanffi excluding vines 3 In (7 6 cm) or
more in diameter at breast height (DBH) regardless of
height
Sapling/Shrub —Woody plants excluding vines less
than 3 in D13H and greater than 3 28 ft (1 m) tail
Herb —Ali herbaceous (non - woody) plants regardless
of size and woody plants less than 3.28 ft tall
Woody vine —Ail woody vines greater than 3 28 ft in
height
5
6
7
B
8
10
11
12
Woody Vine Stratum (Plot size 3 t7 O = Total Cover
1 TOK,Cb�eldron 1--61 G4.1 5 -�
Hydrophytic
Vegetation
Present? Yes K _ No
2 Ga s rah c an (0 __
3
4 V1hf fo}✓r �_ N
5
6
0 = Total Cover
Remarks (include photo numbers here or on a separate sheet)
T\t h7d -oQhy -6c, VcDQkw zt ,' cx4e -rov)
hy)
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version

SOIL
Sampling Paint 01) Z
Profile Description (Describe to the depth needed to document the indicator or confirm the absence of Indicators)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) T Loc� Texture Remarks
0 -8 oa
e C-Concentretion D =De letlon RM= Reduced Matrix MS--Masked Sand Grains =Location PL --Pore thin M= Matrix
Hydric Soil Indicators
Indicators for Problematic Hydric Soils'
_ Histosol (A1)
_ Dark Surface (S7)
_ 2 cm Muck (A10) (MLRA 147)
_ Histic Eplpedon (A2)
_ Polyvalue Below Surface (SS) (MLRA 147 148)
_ Coast Pralne Redox (A16)
_ Black Histrc (A3)
_ Thin Dark Surface (S9) (MLRA 147 148)
(MLRA 147 148)
_ Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Solis (F19)
_ Stratified Layers (A5)
Depleted Matrix (F3)
(MLRA 13% 147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
_ Red Parent Material (TF2)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
_ Very Shallow Dark Surface (fF12)
_ Thick Dark Surface (Al2)
_ Redox Depressions (FB)
_ Other (Explain in Remarks)
_ Sandy Mucky Mineral (S1) (LRR N
_ Iron - Manganese Masses (F12) (LRR N
MLRA 147 148)
MLRA 136)
_ Sandy Gleyed Matrix (34)
_ Umbnc Surface (F13) (MLRA 136 122)
"Indicators of hydrophylk vegetation and
_ Sandy Redox (S5)
_ Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present,
_ Stripped Matrix (S6)
unless disturbed or problematic
Type
Depth (Inchesp
Hydric Soil Present? Yes_)( _ No
`rl� - h7dnC, Sol I LrI4rIo,--) has mz4-
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version

wh J
WETLAND DETERMINATION DATA FORM - Eastern Mount/ainsra�n_d Piedmont
Project/Site NG(6$' ✓S �(+ T-/j�rC,6n -,iZ City /County• r11a�1� Y� � �17�f�1"�� Sampling Date i Z AL
Applicant/Owner HOOT I State _ (- Sampling Point Rt" 3
Investigator(s) r1-51- 'S8911i01,', Section Township Range /Urr!'t
Landform (hillslope terrace etc) %l1 1+51 oPQ- Local relief (concave convex none) i aYlGav Q Slope(/) I
Subregion (.RR or MLRA) i /b 1 � p Let It 10 N Long 41 T9 4 G W Datum k
Soil Map Unit Name F o n NWI classification NIA
Are climatic / hydrologic conditions on the site typical for this time of year? Yes )< No Of no explain in Remarks.)
Are Vegetation . Soft . or Hydrology significantly disturbed? Are "Normal Circumstances present? Yes X No
Are Vegetation Soil . or Hydrology naturally problematic? (if needed explain any answers in Remarks)
SUMMARY OF FINDINGS - Attach site map showing sampling point locations transects important features etc
Hydrophytic Vegetation Present? Yes K No Is the Sampled Area
Hydric Soil Present? Yes No within a Wetland? Yes No X
Weiland Hydrology Present? Yes No
Remarks
(10 R - j,(- l51G-�011A'
HYDROLOGY
US Army Corps of Engineers Eastern Mountains and Piedmont- interim Version
Welland Hydrology indicators Secondary Indicators (minimum of two rmuired)
Primary Indicators (minimum of one is reouired. check all that aooly) _ Surface Soil Cracks (136)
_ Surface Water (Al) _ True Aquatic Plants (1314) _ Sparsely Vegetated Concave Surface (86)
_ High Water Table (A2) _ Hydrogen Sulfide Odor (C1) _ Drainage Patterns (810)
_ Saturation (A3) _ Oxidized Rhtzospheres on LMng Roots (C3) _ Moss Trim Lines (B16)
_ Water Marks (131) _ Presence of Reduced Iron (C4) _ Dry - Season Water Table (C2)
_ Sediment Deposits (B2) _ Recent Iron Reduction in Tilled Soils (C6) _ Crayfish Burrows (Cfi)
_ Drift Deposits (83) _ Thin Mutt Surface (C7) _ Saturation Visible on Aerial Imagery (C9)
_ Algal Mat or Crust (B4) _ Other (Explain in Remarks) _ Stunted or Stressed Plants (D1)
_ Iron Deposits (85) _ Geomorphic Position (D2)
_ Inundation Visible on Aerial imagery (137) _ Shallow Aquitard (D3)
_ Water-Stained Leaves (139) _ Microtopographic Relief (134)
_ Aquatic Fauna (1313) _ FAC- Neutral Test (D5)
Field Observations
Surface Water Present? Yes No __Z_ Depth (inches)
Water Table Present? Yes No K Depth (inches)
Saturation Present? Yes _ No K Depth (inches)
Wetland Hydrology Present? Yes No
Oncludes capfflary frin
Describe Recorded Data (stream gauge monitoring well aerial photos previous Inspections) if available
Remarks;*
t„ haldfQto� L Ui+cr(orl �cq5 not 6"n ihe�
US Army Corps of Engineers Eastern Mountains and Piedmont- interim Version

VEGETATION (Four Strata) — Use scientific names of plants Sampling Point: Q
3
Absolute Dominant Indicator
Dominance Test worksheet:
Tree
Stratum (Plot size )
% Cover
3O
Species? Status
Number of Dominant Species
1
L+riodancL(r M,o r1:11
_
That Are OBL FACW or FAC (A)
Total Number of Dominant
Species Across All Strata (B)
Percent of Dominant Species
That Am OBL FACW or FAC �� (A/B)
2. i—i via 5 U (Js3 7-0
3 C� f J?a/ V� 15 F*C-
5
6
7
Prevalence Index worksheet
Total % Cover of. Multiply by,
OBL species x 1 =
8
= Total Cover
Saoflna/Shrub
Stratum (Plot size (�
)
FACW species x2=
1
(„ri a,-, ron 4 �1,D r f,\
(C
4
FAC species x3=
2
v5%��n 5 A ens
l D
—E&C
FAC
FACU species x4=
9
Lrq,�ciartt of `j�7fhc�i„1q�(
UPLspecies x5=
Column Totals (A) (8)
Prevalence Index = B/A =
4
5
6
7
Hydrophytic Vegetation Indicators
_ 1 Rapid Test for Hydrophytic Vegetation
2 Dominance Test is >50%
8
9
—
3 Prevalence Index 19 :93 0'
10
_
— 4 Morphological Adaptations' (Provide supporting
=Total Cover
Herb (Plot size 5 )
data In Remarks or on a separate sheet)
1
vbtv } Wv (r
Problematic Hydrophylic Vegetation' ' (Explain)
OCros +1a,7r e5
&U
'Indicators of hydric soil and wetland hydrology must
be present unless disturbed or problematic
3 —
4
Definitions of Four Vegetation Strata
5
Tree — Woody plants excluding vines 3 in (7 6 cm) or
more in diameter at breast height (DBH) regardless of
6
7
height.
8
Sapling/Shrub — Woody plants excluding vines less
g
than 3 in DBH and greater than 3 28 ft (1 m) tell
10
Herb —All herbaceous (non woody) plants regardless
of size and woody plants less then 328 it tall
11
12
Woody vine — All woody vines greater than 3 28 ft In
= Total Cover
Woody
Vine Stratum (Plot size 3 fl )
_
height.
1
Ad"., hett+C
0
Y Nj_
Hydrophytic
Vegetation
2 %f1+5 (_O{r`,1AAe trst to hi FAC
3 bony(" oSrn Cda is At
4
5
6
Present? Yes )< No
= Total Cover
Remarks (Include photo numbers here or on a separate sheet.)
vezy A -rte N c,n4et)D,-� hA5 _Ix_PN m,:4 --
US Army Corps of Engineers Eastern Mountains and Piedmont— Interim Version

SOIL
Sampling Point ac -'
Profile Description (Describe to the depth needed to document the Indicator or confirm the absence of Indicators)
Depth Matrix Redox Features
jnchesl C o %_ Color fmoistl _6_ Tvoe L�ocr Texture __ Remarks
Hydric Soil Indicators
Indicators for Problematic Hydric Soils'
_ Hlstosol (Al)
_ Dark Surface (S7)
_ 2 cm Muck (All 0) (MLRA 147)
_ Hlsflc Epipedon (A2)
_ Polyvalue Below Surface (S8) (MLRA 147 146)
_ Coast Prairie Redox (A16)
_ Black Hlstic (A3)
_ Thin Dark Surface (S9) (MLRA 147 146)
(MLRA 147 148)
_ Hydrogen Sulfide (A4)
_ Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Soils (Fig)
_ Stratified Layers (A5)
_ Depleted Matrix (F3)
(MLRA 136 147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
_ Red Parent Material (TF2)
_ Depleted Below Dark Surface (Al 1)
_ Depleted Dark Surface (F7)
_ Very Shallow Dark Surface (1-1`12)
_ Thick Dark Surface (Al2)
_ Redox Depressions (F8)
_ Other (Explain in Remarks)
_ Sandy Mucky Mineral (S1) (LRR N,
_ Iron - Manganese Masses (F12) (LRR N
MLRA 147 148)
MLRA 136)
_ Sandy Gleyed Matrix (S4)
_ Umbnc Surface (F13) (MLRA 136 122)
' Indicators of hydrophyfic vegetation and
_ Sandy Redox (S5)
_, Piedmont Floodplam Soils (F19) (MLRA 148)
wetland hydrology must be present,
_ Stripped Matrix (S6)
unless disturbed or problematic.
Type
Depth Qnches)
Hydric Sob Present? Yes No,�
'1, C hXlSn C 5 -11 I �.r I r has Ftl> J-- .fit -'4 A' U —
US Army Corps of Engineers Easters Mountains and Pladmont— Interim Version

WD
WETLAND DETERMINATION DATA FORM — Eastern M},ountains and Piedmont
Project/Site NC 6`b VS 511 J nt „rC.6mC, City/County- ��Dt� rCl Sampling Date Zg t'Z
Applicant/Owner NGD a`�' .. State N (. Sampling Point QG3
Invesligator(s) 56u4op Section Township Range fJr'ft
Landfonn (hlflslope terrace etc) 44-3 06 1 Local relief (concave convex none) C0YtCm C Slope (A) e n
Subregion (LRR or MLRA) "A13-6 -i Let 36 0049 N Long q9 1V46 W Datum W&5
Sotl Map Unit Name F-A-,\ n2 t0' r\ NWI classification -V i” n►a�ed
Are climatic / hydrologic conditions on the site typical for this time of year? Yes_ Na (If no explain in Remarks )
Are Vegetation . Soil . or Hydrology significantly disturbed? Are 'Normal Circumstances present? Yes No
Are Vegetation Soil . or Hydrology naturally problematic? Of needed explain any answers in Remarks )
SUMMARY OF FINDINGS — Attach site map showing sampling point locations transects important features etc
Hydrophytic Vegetation Present? Yes No Is the Sampled Area
Hyddc Soil Present? Yes x No within a Wetland? Yes K No
Welland Hydrology Present? Yes T No
DKA-A Po n+ 15 J���dtC-�- +Una 1
HYDROLOGY
US Army Corps of Engineers Eastern Mountains and Piedmont– Interim Version
Wetland Hydrology Indicators Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is reauired check all that apply) _ Surface Soil Cracks (B6)
_ Surface Water (Al) _ True Aquatic Plants (B14) _ Sparsely Vegetated Concave Surface (BS)
High Water Table (A2) Hydrogen Sulfide Odor (Cl) _ Drainage Patterns (B10)
Saturation (A3) _ Oxidized Rhlzospheres on Living Roots (0) _ Moss Tnm Lines (816)
_ Water Marks (B1) _ Presence of Reduced Iron (C4) _ Dry - Season Water Table (C2)
_ Sediment Deposits (B2) _ Recent Iron Reduction In Tilled Soils (C6) _ Crayfish Burrows (C8)
_ Drift Deposits (133) _ Thin Muck Surface (C7) _ Saturation Visible on Aerial Imagery (C9)
_ Algal Mat or Crust (B4) _ Other (Explain in Remarks) _ Stunted or Stressed Plants (Di)
_ Iron Deposits (B5) _ C,aomorphlc Position (02)
Inundation Visible on Aerial Imagery (B7) _ Shallow Aquitard (0)
^_
Water Stained Leaves (B9) _ Mkxotopographic Relief (134)
_ Aquatic Fauna (B13) FAGNeutral Test (D5)
Field Observations
Surface Water Present? Yes No Depth (inches)
Water Table Present? Yes No Depth (inches}
Saturation Present? Yes No Depth (Inches)
Wetland Hydrology Present? Yes No
ca ill frm
Describe Recorded Data (stream gauge monitoring well aerial photos previous Inspections) If evallable.
Remarks
r_ r
Gr l +O-rt Ov1 n ay Lea.,\ tv -4'
US Army Corps of Engineers Eastern Mountains and Piedmont– Interim Version

VEGETATION (Four Strata) - Use scientific names of plants Sampling Point �� 3
Absolute Dominant Indicator Dominance Test worksheat
Tree Stratum (Plot size 30 k Cover Species? Status Number of Dominant Species
1 _ _ __ _ That Are OBL FACW or FAC (A)
2 Total Number of Dominant Q
3 Species Across All Strata U (B)
4
5 That Ara or
Ara OBL FACWor FAC �o (AB)
6
7 Prevalence Index worksheet
8
Total %Coverof. MulBolvbv.
= Total Cover O
SBOgno/Shrub S
Stratum (Plot size S )
) F
FAC species x2=
1
1 e
e n (,n 3
3 0 -/ _ FAt F
FAC species X3=
2 t
t c v r T J M 1
110 1, F
FACU spades x4=
3 Q.( o Aco� a^nE on 2-0 `, FACE U
4 T C
5
Prevalence Index = B/A =
6
Hydrophytic Vegetation Indicators
8
_ 1 Rapid Test for Hydrophytic Vegetation
8 _
2 Dominance Test Is >50%
9
9 _
3 Prevalence Index is s3 0'
_ 3
Herb S
Stratum (Plot size d
=Total Cover —
data in Remarks or on a separate sheet)
1 v
vW S bck�l t � (J 5 )
(o FA —
— Problematic Hydrophytic Vagetaton' (Explain)
2 9v-k(Y1en°\ L4 (rndf r4q —10 '
3 b
be present unless disturbed or problematic
4 D
Definitions of Four Vegetation Strata
5
Tree - Woody plants excluding vines 3 in Q 6 cm) or
more in diameter at breast height (DBH) regardless of
6 T
7 h
height
8 S
9 t
than 3 In DBH and greater than 3 28 ft (1 m) tag
10
Herb -Ali herbaceous (non - woody) plants regardless
11 H
of size and woody plants less Hen 328 It tail
12
Woody vine - All woody vines greater than 3 28 ft in
20 = Total Cover W
pod v na, tretu M (PI s )
1 Ha cco\ Kr -k)( I0 �N17 -J
2. t @V%Dr -%55- .A`f�f t rh - _� LLl-
3 Lori cerA uOO f1 C.\ FAC
4 Hydrophytic
6 Vegetation
8 Present? Yes �_ No
1�1 = Total Cover
Remarks (Include ohoto numbers here or on a separate sheet )
` ke. h14`09k'f- c h%) SeevA me,+--
US Army Corps of Engineers Eastern Mountains and Piedmont - Interim Version

SOiL Sampling Point aC 3
Profile Description (Describe to the depth needed to document the indicator or confirm the absence of indicators )
Depth
Matrix
Redox Features
_ Dark Surface (S7)
(Inches)
Col of
Color (moist) TVDe�Loc�
Texture Remarks
o — I
D`/ L
(MLRA 147 148)
oa
Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Soils (Fig)
L
�� `� ((on
(MLRA 136,147)
ZR
% ( L
Gl o� 1,•rn
Hydric Soil Indicators
Indicators for Problematic Hydric Soils'
_ Histosol (Al)
_ Dark Surface (S7)
_ 2 cm Muck (A10) (MLRA 147)
_ Hisfic Epipedon (A2)
_ Polyvalue Below Surface (SS) (MLRA 147 148)
_ Coast Prelrie Redox (Al 6)
_ Black Hisdc (A3)
_ Thin Dark Surface (SB) (MLRA 147 148)
(MLRA 147 148)
— Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Soils (Fig)
_ Stratified Layers (A5)
Depleted Matrix (F3)
(MLRA 136,147)
_ 2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
_ Red Parent Material (TF2)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
_ Very Shallow Dark Surface (TF12)
_ Thick Dark Surface (Al2)
_ Redox Depressions (F8)
_ Other (Explain in Remarks)
_ Sandy Mucky Mineral (St) (LRR N
_ Iron Manganese Masses (F12) (LRR N
MLRA 147 14B)
MLRA 136)
_ Sandy Oleyed Matrix (S4)
_ Umbnc Surface (F13) (MLRA 136 122)
'Indicators of hydrophytic vegetation and
_ Sandy Redox (S5)
_ Piedmont Floodplain Soils (Fig) (MLRA 148)
wetland hydrology must be present,
_ Stripped Matnx (S6)
unless disturbed or problematic
Restrictive Layer (if observed)
Type
Depth (Inches)
Hydric Soil Present? Yes ". No
5,7, 1 Gfi�ilflY) kltS � ,ze.,'l /ne4—
US Army Corps of Engineers Eastern Mountains and Piedmont — Interim Version
1

WA
WETLAND RATING WORKSHEET Fourth Version
Prod ect Name NC 68 l U5 Nearest Road N(- 311
County (.p,; j Co, Wetland area acres Wetland width 10 feet
Name of evaluator X51 J E,en%n rti Date 1012.g 110
Wetland location
_ on pond or lake
_ on perennial stream
— on intermittent stream
_ within interstream divide
other eehc nr_f0.1 �ret ln4AC,
Soil series \44c 5
predominantly organic humus muck or
peat
predominantly mineral non sandy
—predominantly sandy
Hydraulic factors
steep topography
ditched or channeltzed
total wetland width > 100 feet
Wetland type (select one)"
_ Bottomland hardwood forest
' Headwater forest
_ Swamp forest
_ Wet flat
_ Pocosin
_ Bog forest
Adjacent land use
(within % mile upstream, upslope or radius)
_ forested/natural vegetation Zo %
— agriculture, urban/suburban -
impervious surface 122%
Dominant vegetation
(1) _ S"I x nlK(ON
(2) 1-1$VIA4ftl 6 C 4 /( ac,i"
(3) L,riode�jicn,)
Flooding and wetness
semipermanently to permanently flooded or
inundated
_ seasonally flooded or inundated
intermittently flooded or temporary surface water
— no evidence of flooding or surface water
_ Pme savanna
_ Freshwater marsh
_ Bog/fen
_ Ephemeral wetland
_ Carolina bay
Other
The rating system cannot be applied to salt or brackish marshes or stream channels
R
Water storage
�_ x 4 00 =
0 ^^
A
Bank/Shoreline stabilization
D x 4 00 =
Wetland
T
Pollutant removal
**x 5 00 =
0 rating
I
Wildlife habitat
U x 2 00 =
13
N
Aquatic life value
x 4 00 =
0
G
Recreation/Education
0 x 100 =
** Add 1
point if in sensitive watershed and >10% nonpoint source disturbance within % mile upstream upslope or radius

WETLAND RATING WORKSHEET Fourth Version
Project Name NG 61 f VS If I Zn+-er0 ,n %P, Nearest Road 05 3
County Gvll fvrd Wetland area 0 15 acres Wetland width feet
Name of evaluator E.5T - 5 6xn4pY_) Date & 1Z3 /I Z.
Wetland location
on pond or lake
on perennial stream
_ on intermittent stream
within mterstream divide
other
Soil series W I I KCS
_ predominantly organic
peat
predominantly mineral
predommantly sandy
Hydraulic factors
humus, muck or
non sandy
_ steep topography
ditched or channelized
total wetland width > 100 feet
Wetland type (select one)"
_ Bottomland hardwood forest
Headwater forest
_ Swamp forest
_ Wet flat
_ Pocosin
_ Bog forest
Adjacent land use
(within 1/s mile upstream, upslope, or radius)
_ forested/natural vegetation �o
_ agriculture, urban/suburban 1
_ impervious surface 10_%
Dominant vegetation
(1) Are-r rvbru^
(2) Ak-s 5f1" r- 1,4-
(3) (0,K(c0denJr0r) (-c4c kn5
Flooding and wetness
_ sermpermanently to permanently flooded or
inundated
_ seasonally flooded or inundated
X intermittently flooded or temporary surface water
_ no evidence of flooding or surface water
_ Pine savanna
_ Freshwater marsh
_ Bog/fen
— Ephemeral wetland
_ Carolina bay
_ Other
The rating system cannot be applied to salt or brackish marshes or stream channels
R
Water storage
Z x 4 00 =
A
Bank/Shoreline stabilization
Z x 4 00 =
® Wetland
T
Pollutant removal
3 '' x 5 00 =
F 15 rating
I
Wildlife habitat
x2 00 =
®
N
Aquatic life value
Z x4 00 =
G
Recreation/Education
0 x 100 =
0
** Add 1
point if in sensitive watershed and >10% nonpoint source disturbance within
% mile upstream upslope or radius

WC
WETLAND RATING WORKSHEET Fourth Version
ProjectName NC (A US 3J Nearest Road f,
County (9" Ifra Wetland area O 01 acres Wetland width Z feet
Name of evaluator Sr - �T-Ac-m6 n Date 614 /1 2
Wetland location
on pond or lake
_ on perennial stream
on intermittent stream
within mterstream divide
other
Soil series \N 1 � ke5
predominantly organic - humus muck, or
peat
predominantly mineral non sandy
predominantly sandy
Hydraulic factors
steep topography
ditched or channelized
total wetland width?: 100 feet
Wetland type (select one)*
_ Bottomland hardwood forest
ZC Headwater forest
_ Swamp forest
_ Wet flat
_ Pocosm
_ Bog forest
Adjacent land use
(within %s mile upstream, upslope, or radius)
_ forested/natural vegetation -LO-21.
agriculture urban/suburban 7o %
_ impervious surface Za %
Dominant vegetation
(i) A --r rv6rv.\
(2) L� q,�i d aM�4 r- 5 �a talc a FEyo�
(3) dc A,,fe r.,, j.
Flooding and wetness
_ semtpermanently to permanently flooded or
inundated
seasonally flooded or inundated
_ intermittently flooded or temporary surface water
x no evidence of flooding or surface water
_ Pine savanna
_ Freshwater marsh
_ Bog /fen
_ Ephemeral wetland
_ Carolina bay
Other
The rating system cannot be applied to salt or brackish marshes or stream channels
R
Water storage
x4 00 =
A
Bank/Shorelme stabilization
x 4 00 =
Wetland
T
Pollutant removal
x 5 00 =
rating
I
Wildlife habitat
x 2 00 =
0
I
N
Aquatic life value
�_ x 4 00 =
G
Recreation/Education
O x 100 =
0
** Add 1
point if in sensitive watershed and >10% nonpomt source disturbance within
Y2 mile upstream, upslope or radius

WD
WETLAND RATING WORKSHEET Fourth Version
ProlectNameNG 4% Ivs 311 . Nearest Road NC- �$
County Wetland area ©, n l acres Wetland width 3 D feet
Name of evaluator F 52 - S6 Date 6 tL$ II 2
Wetland location
_ on pond or lake
_ on perennial stream
)< on intermittent stream
_ within interstream divide
other
Soil series C-_n o''-�
_ predornmantly organic - humus
peat
muck or
5� predominantly mineral non sandy
_ predominantly sandy
Hydraulic factors
steep topography
_ ditched or channelized
total wetland width > 100 feet
Wetland type (select one)
_ Bottomland hardwood forest
X Headwater forest
_ Swamp forest
_ Wet flat
_ Pocosm
Bog forest
Adjacent land use
(within %z mile upstream upslope, or radius)
_ forested/natural vegetation _T0_0/.
_ agriculture urban/suburban 55-%
_ impervious surface
Dominant vegetation
(1) L 3v5-tru-� Sinen5 c.
(2) Ac,-r f ybry n-\
(3) Ule kmc-n Un C� l t) .n c,,
Flooding and wetness
semipermanently to permanently flooded or
inundated
_ seasonally flooded or inundated
intermittently flooded or temporary surface water
_ no evidence of flooding or surface water
_ Pine savanna
_ Freshwater marsh
_ Bog /fen
Ephemeral wetland
_ Carolina bay
_ Other
The rating system cannot be applied to salt or brackish marshes or stream channels
R
Water storage
x 4 00 =
A
Bank/Shoreline stabilization
Z x 4 00 =
Wetland
T
Pollutant removal
—1— `+ x 5 00 =
rating
I
Wildlife habitat
x 2 00 =
0
3,
N
Aquatic life value
2 x4 00 =
G
Recreation/Education
O x 1 00 =
0
** Add 1
point if in sensitive watershed and >10% nonpoint source disturbance within
% mile upstream, upslope or radius

SA WD
APPROVED JURISDICTIONAL DETERMINATION FORM
U S Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook
SECTION I BACKGROUND INFORMATION
A REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD)
B DISTRICT OFFICE FILE NAME AND NUMBER
C PROJECT LOCATION AND BACKGROUND INFORMATION NC 68 / NC 311 Interchange STIP U 5169 Evaluator ]Benton
State NC County /parish/borough Guilford City High Point
Center coordinates of site (lat/long in degree decimal format) Lat 36 00438 N Long 79 98972 L
Universal Transverse Mercator 17S 591050 3984905
Name of nearest waterbody West Fork Deep River
Name of nearest Traditional Navigable Water (TNW) Into which the aquatic resource flows Cape Fear River
Name of watershed or Hydrologic Unit Code (HUC) Deep 03030003
® Check if map /diagram of review area and/or potential jurisdictional areas is /are available upon request
❑ Check if other sites (e g offsite mitigation sites disposal sites etc ) are associated with this action and are recorded on a
different JD form
D REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY)
❑ Office (Desk) Determination Date
❑ Field Determination Date(s)
SECTION H SUMMARY OF FINDINGS
A RHA SECTION 10 DETERMINATION OF JURISDICTION
There Arse o navigable waters of the US within Rivers and Harbors Act (1114A)jurisdiction (as defined by 33 CFR part 329) in the
review area [Required]
❑ Waters subject to the ebb and flow of the tide
❑ Waters are presently used or have been used in the past or may be susceptible for use to transport interstate or foreign commerce
Explain
B CWA SECTION 404 DETERMINATION OF JURISDICTION
There Are waters of the U S within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area [Required]
1 Waters of the U S
a Indicate presence of waters of U S in review area (check all that apply) i
❑ TNWs including territorial seas
❑ Wetlands adjacent to TNWs
® Relatively permanent waters2 (RPWs) that flow directly or indirectly into TNWs
❑ Non RPWs that flow directly or indirectly into TNWs
® Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters including isolated wetlands
b Identify (estimate) size of waters of the U S in the review area
Non wetland waters 462 linear feet 2 5 ave width (ft) and/or acres
Wetlands 0 02 acres
c Limits (boundaries) of jurisdiction based on Established I OHWM
Elevation of established OHWM (if known) Established by RGL 05 05 guidelines
2 Non regulated waters /wetlands (check if applicable) 3
❑ Potentially jurisdictional waters and /or wetlands were assessed within the review area and determmed to be not jurisdictional
Explain
i Boxes checked below shall be supported by completing the appropriate sections in Section Ill below
2 For purposes of this form an FPW is defined as a tributary that is not a TNW and that typically flows year round or has continuous flow at least seasonally
(e g typically 3 months)
' Supporting documentation is presented in Section iII F

SECTION III CWA ANALYSIS
A TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs If the aquatic resource is a TNW complete
Section III A 1 and Section III D 1 only if the aquatic resource is a wetland adjacent to a TNW complete Sections III A 1 and 2
and Section III D 1 otherwise see Section III B below
1 TNW
Identify TNW
Summarize rationale supporting determination
Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is adjacent
CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY)
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands if any and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met
The agencies will assert jurisdiction over non navigable tributaries of TNWs where the tributaries are relatively permanent
waters" (RPWs) ► e tributaries that typically flow year round or have continuous flow at least seasonally (e g typically 3
months) A wetland that directly abuts an RPW is also jurisdictional If the aquatic resource is not a TNW but has year round
(perennial) flow skip to Section HI D 2 If the aquatic resource is a wetland directly abutting a tributary with perennial flow
skip to Section HI D 4
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water even
though a significant nexus finding is not required as a matter of law
If the waterbody4 is not an RPW or a wetland directly abutting an RPW a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW If the tributary has adjacent wetlands the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands This significant nexus evaluation that combines for
analytical purposes the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary or its adjacent wetlands or both If the JD covers a tributary with adjacent wetlands complete Section III B 1 for
the tributary Section HI B 2 for any onsite wetlands and Section III B 3 for all wetlands adjacent to that tributary both onsite
and offsite The determination whether a significant nexus exists is determined in Section HI C below
1 Characteristics of non TNWs that flow directly or indirectly into TNW
(i) General Area Conditions
Watershed size 20 square miles
Drainage area 15 acres`
- -
Average annual rainfall 42 inches
Average annual snowfall 10 inches
(u) Physical Characteristics
(a) Relationship with TNW
❑ Tributary flows directly into TNW
® Tributary flows through 3_ tributaries before entering TNW
Project waters are 30 (or m� a river miles from TNW
Project waters are it (or less) river miles from RPW
Project waters are 30 (or more) aerial (straight) miles from TNW
Project waters are 1 or less) aerial (straight) miles from RPW
Project waters cross or serve as state boundaries Explain
Identify flow route to TNW5 UT to West Fork Deep River West Fork Deep River Deep River Cape Fear River
Tributary stream order if known V
Note that the Instructional Guidebook contains additional information regarding swales ditches washes and erosional features generally and in the and
West
5 Flow route can be described by identifying e g tributary a which flows through the review area, to flow into tributary b which then flows into TNW

(b) General Tributary (check all that apply)_
Tributary is ® Natural
❑ Artificial (man made) Explain
❑ Manipulated (man altered) Explain
Tributary properties with respect to top of bank (estimate)
Average width 2 5 feet
Average depth 2 feet
Average side slopes 271
Primary tributary substrate composition (check all that apply)
® Silts ® Sands
® Cobbles ® Gravel
❑ Bedrock ❑ Vegetation Type // cover
❑ Other Explain
❑ Concrete
❑ Muck
Tnbutary condition/stability [e g highly eroding sloughing banks] Explain extensive bank failure around culvert
Presence of run/nffle /pool complexes Explain moderate
Tributary geometry Meandermg
Tributary gradient (approximate average slope) 0 2 /
(c) Flow
Tributary provides for Seasonal fl
Estimate average number of flow events in review area/year 20 (�— or ga
re
Describe flow regime Weak flow at time of field visit
Other information on duration and volume
Surface flow is Confined Characteristics
Subsurface flow Unkn wo Explain findings
❑ Dye (or other) test performed
Tributary has (check all that apply)
® Bed and banks
® OHWM6 (check all indicators that apply)
® clear natural line impressed on the bank
❑
® changes in the character of soil
❑
❑ shelving
® vegetation matted down bent or absent
® leaf litter disturbed or washed away
® sediment deposition
❑
❑ water staining
❑
❑ other (list)
❑ Discontinuous OHWM 7 Explain
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
If factors other than the OHWM were used to determine lateral extent of CWA junsdichon (check all that apply)
❑ High Tide Line indicated by ❑ Mean High Water Mark indicated by
❑ oil or scum line along shore objects ❑ survey to available datum
❑ fine shell or debris deposits (foreshore) ❑ physical markings
❑ physical markings / characteristics ❑ vegetation lines /changes in vegetation types
❑ tidal gauges
❑ other (list)
(m) Chemical Characteristics
Characterize tributary (e g water color is clear discolored oily film water quality general watershed characteristics etc )
Explain water color is clear
Identify specific pollutants if known possible nutrient loading from surrounding residential area
6A natural or man made discontinuity in the OHWM does not necessarily sever jurisdiction (e g where the stream temporarily flows underground or where
the OHWM has been removed by development or agricultural practices) Where there is a break in the OHWM that is unrelated to the waterbody s flow
regime (e g flow over a rock outcrop or through a culvert) the agencies will look for indicators of flow above and below the break
Ibid

(iv) Biological Characteristics Channel supports (check all that apply)
® Riparian corridor Characteristics (type average width) Forested 100 feet
❑ Wetland fringe Characteristics
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish /spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
2 Characteristics of wetlands adjacent to non TNW that flow directly or indirectly into TNW
(i) Physical Characteristics
(a) General Wetland Characteristics
Properties
Wetland size acres
Wetland type Explain
Wetland quality Explain
Project wetlands cross or serve as state boundaries Explain
(b) General Flow Relationship with Non TNW
Flow is Pick List Explain
Surface flow is Pick ListList
Characteristics
Subsurface flow Pick ListList Explain findings
❑ Dye (or other) test performed
(c) Wetland Adjacency Determination with Non TNW
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection Explain
❑ Ecological connection Explain
❑ Separated by berm/bamer Explain
(d) Proximity (Relationship) to TNW
Project wetlands are Pick List river miles from TNW
Project waters are Pick�List aerial (straight) miles from TNW
Flow is from Pick List.
Estimate approximate location of wetland as within the Pick List floodplain
(u) Chemical Characteristics
Characterize wetland system (e g water color is clear brown oil film on surface water quality general watershed
characteristics etc ) Explain
Identify specific pollutants if known
(in) Biological Characteristics Wetland supports (check all that apply)
❑ Ripanan buffer Characteristics (type average width)
❑ Vegetation type /percent cover Explain
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish/spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
3 Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis

For each wetland specify the following
Directly abuts9 (Y/N) Size (in acres) Directly abuts9 (Y/N) Size (in acres)
Summarize overall biological chemical and physical functions being performed
C SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical physical and biological integrity
of a TNW For each of the following situations a significant nexus exists if the tributary in combination with all of its adjacent
wetlands has more than a speculative or insubstantial effect on the chemical physical and/or biological integrity of a TNW
Considerations when evaluating significant nexus include but are not limited to the volume duration and frequency of the flow
of water in the tributary and its proximity to a TNW and the functions performed by the tributary and all its adjacent
wetlands It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e g between a
tributary and its adjacent wetland or between a tributary and the TNW) Similarly the fact an adjacent wetland lies within or
outside of a floodplam is not solely determinative of significant nexus
Draw connections between the features documented and the effects on the TNW as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include for example
Does the tributary in combination with its adjacent wetlands (if any) have the capacity to carry pollutants or flood waters to
TNWs or to reduce the amount of pollutants or flood waters reaching a TNW'?
Does the tributary in combination with its adjacent wetlands (if any) provide habitat and hfecycle support functions for fish and
other species such as feeding nesting spawning or rearing young for species that are present in the TNW?
Does the tributary in combination with its adjacent wetlands (if any) have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs9
Does the tributary in combination with its adjacent wetlands (if any) have other relationships to the physical chemical or
biological integnty of the TNW9
Note the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below
Significant nexus findings for non RPW that has no adjacent wetlands and flows directly or indirectly into TNWs Explain
findings of presence or absence of significant nexus below based on the tnbutary itself then go to Section III D
Significant nexus findings for non RPW and its adjacent wetlands where the non RPW flows directly or indirectly into
TNWs Explain findings of presence or absence of significant nexus below based on the tributary in combination with all of its
adjacent wetlands then go to Section III D
Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW Explain findings of
presence or absence of significant nexus below based on the tributary in combination with all of its adjacent wetlands then go to
Section III D
D DETERMINATIONS OF JURISDICTIONAL FINDINGS THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY)
1 TNWs and Adjacent Wetlands Check all that apply and provide size estimates in review area
❑ TNWs linear feet width (ft) Or acres
0 Wetlands adjacent to TNWs acres
RPWs that flow directly or indirectly into TNWs
❑ Tributaries of TNWs where tributaries typically flow year round are jurisdictional Provide data and rationale indicating that
tributary is perennial
® Tributanes of TNW where tnbutanes have continuous flow seasonally (e g typically three months each year) are
jurisdictional Data supporting this conclusion is provided at Section IiI B Provide rationale indicating that tributary flows
seasonally Good bed and bank grade control and riffle /pool sequence Wrack lines and hydnc soils also present

Provide estimates forjunsdicuonal waters in the review area (check all that apply)
® Tnbutary waters 38 linear feet 2 5 ave width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
Non RPWss that flow directly or indirectly into TNWs
❑ Waterbody that is not a TNW or an RPW but flows directly or indirectly into a TNW and it has a significant nexus with a
TNW is jurisdictional Data supporting this conclusion is provided at Section III C
Provide estimates for jurisdictional waters within the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs
® Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands
❑ Wetlands directly abutting an RPW where tributaries typically flow year round Provide data and rationale
indicating that tributary is perennial in Section III D 2 above Provide rationale indicating that wetland is
directly abutting an RPW
® Wetlands directly abutting an RPW where tributaries typically flow seasonally Provide data indicating that tributary
seasonal in Section III B and rationale in Section III D 2 above Provide rationale indicating that wetland is directly
abutting an RPW The wetland is hydrologically connected to the RPW therefore it is junsdictional
Provide acreage estimates for junsdictional wetlands in the review area 0 02 acres
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs
❑ Wetlands that do not directly abut an RPW but when considered in combination with the tnbutary to which they are adjacent
and with similarly situated adjacent wetlands have a significant nexus with a TNW are juns►dictional Data supporting this
conclusion is provided at Section III C
Provide acreage estimates for jurisdictional wetlands in the review area acres
Wetlands adjacent to non RPWs that flow directly or indirectly into TN%
❑ Wetlands adjacent to such waters and have when considered in combination with the tnbutary to which they are adjacent and
with similarly situated adjacent wetlands have a significant nexus with a TNW are jurisdictional Data supporting this
conclusion is provided at Section III C
Provide estimates for jurisdictional wetlands in the review area acres
7 Impoundments of jurisdictional waters 9
As a general rule the impoundment of a jurisdictional tributary remains jurisdictional
❑ Demonstrate that impoundment was created from waters of the U S or
❑ Demonstrate that water meets the cnteria for one of the categories presented above (1 6) or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below)
ISOLATED [INTERSTATE OR INTRA STATE] WATERS INCLUDING ISOLATED WETLANDS THE USE
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY) io
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce
❑ which are or could be used for industrial purposes by industries in interstate commerce
❑ Interstate isolated waters Explain
Q Other factors Explain
Identify water body and summarize rationale supporting determination
See Footnote # 3
9 To complete the analysis refer to the key in Section III D 6 of the Instructional Guidebook
10 Pnor to asserting or declining CWA junsdict►on based solely on this category Corps Distncts wdl elevate the action to Corps and EPA HQ for
review consistent with the process descnbed in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos

Provide estimates for Jurisdictional waters in the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
❑ Wetlands acres
F NON JURISDICTIONAL WATERS INCLUDING WETLANDS (CHECK ALL THAT APPLY)
❑ If potential wetlands were assessed within the review area these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements
❑ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce
❑ Prior to the Jan 2001 Supreme Court decision in SWANCC the review area would have been regulated based solely on the
Migratory Bird Rule (MBR)
❑ Waters do not meet the Significant Nexus standard where such a finding is required for Jurisdiction Explain
❑ Other (explain if not covered above)
Provide acreage estimates for non Jurisdictional waters in the review area where the sole potential basis of Jurisdiction is the MBR
factors (i a presence of migratory birds presence of endangered species use of water for irrigated agriculture) using best professional
Judgment (check all that apply)
❑ Non wetland waters (i e rivers streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List type of aquatic resource
❑ Wetlands acres
Provide acreage estimates for non Jurisdictional waters in the review area that do not meet the Significant Nexus standard where such
a finding is required for Jurisdiction (check all that apply)
❑ Non wetland waters (i e rivers streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List type of aquatic resource
❑ Wetlands acres
SECTION IV DATA SOURCES
A SUPPORTING DATA Data reviewed for JD (check all that apply checked items shall be included in case file and where checked
and requested appropriately reference sources below)
® Maps plans plots or plat submitted by or on behalf of the applicant/consultant
® Data sheets prepared/submitted by or on behalf of the applicant/consultant
❑ Office concurs with data sheets /delineation report
❑ Office does not concur with data sheets /delineation report
❑ Data sheets prepared by the Corps
❑ Corps navigable waters study
® U S Geological Survey Hydrologic Atlas
❑ USGS NHD data
® USGS 8 and 12 digit HUC maps
® U S Geological Survey map(s) Cite scale & quad name 1 24 000 Guilford
® USDA Natural Resources Conservation Service Soil Survey Citation Soil Survey for Guilford County NC
❑ National wetlands inventory map(s) Cite name
❑ State /Local wetland inventory map(s)
❑ FEMA/FIRM maps
❑ 100 year Floodplam Elevation is (National Geodectic Vertical Datum of 1929)
® Photographs ® Aerial (Name & Date) 2010 DigitalGlobe
or ❑ Other (Name & Date)
❑ Previous determination(s) File no and date of response letter
❑ Applicable /supporting case law
❑ Applicable /supporting scientific literature
❑ Other information (please specify)
B ADDITIONAL COMMENTS TO SUPPORT JD This form represents intermittent SA and wetland WD

ME
APPROVED JURISDICTIONAL DETERMINATION FORM
U S Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook
SECTION I BACKGROUND INFORMATION
A REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD)
B DISTRICT OFFICE FILE NAME AND NUMBER
C PROJECT LOCATION AND BACKGROUND INFORMATION NC 68 / NC 311 Interchange STIP U 5169 Evaluator ]Benton
State NC County /parish/borough Guilford City High Point
Center coordinates of site (lat/long in degree decimal format) Lat 35 99948 N Long 79 99379 W
Universal Transverse Mercator 17S 590689 3984359
Name of nearest waterbody West Fork Deep River
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows Cape Fear River
Name of watershed or Hydrologic Unit Code (HUC) Deep 03030003
® Check if map /diagram of review area and /or potential Jurisdictional areas is /are available upon request
❑ Check if other sites (e g offsite mitigation sites disposal sites etc ) are associated with this action and are recorded on a
different JD form
D REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY)
❑ Office (Desk) Determination Date
❑ Field Determination Date(s)
SECTION H SUMMARY OF FINDINGS
A RHA SECTION 10 DETERMINATION OF JURISDICTION
There Areno navigable waters of the US within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area [Required]
❑ Waters subject to the ebb and flow of the tide
❑ Waters are presently used or have been used in the past or may be susceptible for use to transport interstate or foreign commerce
Explain
B CWA SECTION 404 DETERMNATION OF JURISDICTION
There Are waters of the US within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area [Required]
1 Waters of the U S
a Indicate presence of waters of U S in review area (check all that apply) i
❑ TNWs including territorial seas
❑ Wetlands adjacent to TNWs
® Relatively permanent watersz (RPWs) that flow directly or indirectly into TNWs
❑ Non RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
❑ Impoundments ofjunsdictional waters
❑ Isolated (interstate or intrastate) waters including isolated wetlands
b Identify (estimate) size of waters of the U S in the review area
Non wetland waters 8 linear feet 3 ave width (ft) and/or acres
Wetlands acres
c Limits (boundaries) of jurisdiction based on Established I OHWM
Elevation of established OHWM (if known) Established by RGL 05 05 guidelines
2 Non regulated waters/wetlands (check if applicable) 3
❑ Potentially jurisdictional waters and /or wetlands were assessed within the review area and determined to be not jurisdictional
Explain
Boxes checked below shall be supported by completing the appropriate sections in Section III below
Z For purposes of this form an RPW is defined as a tributary that is not a TNW and that typically flows year round or has continuous flow at least seasonally
(e g typically 3 months)
3 Supporting documentation is presented in Section III F

SECTION III CWA ANALYSIS
A TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs If the aquatic resource is a TNW complete
Section III A 1 and Section III D 1 only if the aquatic resource is a wetland adjacent to a TNW complete Sections III A 1 and 2
and Section III D 1 otherwise see Section III B below
1 TNW
Identify TNW
Summarize rationale supporting determination
2 Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is adjacent
B CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY)
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands if any and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met
The agencies will assert jurisdiction over non navigable tributaries of TNWs where the tributaries are relatively permanent
waters (RPWs) i e tributaries that typically flow year round or have continuous flow at least seasonally (e g typically 3
months) A wetland that directly abuts an RPW is also jurisdictional If the aquatic resource is not a TNW but has year round
(perennial) flow skip to Section III D 2 If the aquatic resource is a wetland directly abutting a tributary with perennial flow
skip to Section III D 4
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water even
though a significant nexus finding is not required as a matter of law
If the waterbody° is not an RPW or a wetland directly abutting an RPW a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW If the tributary has adjacent wetlands the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands This significant nexus evaluation that combines for
analytical purposes the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary or its adjacent wetlands or both If the JD covers a tributary with adjacent wetlands complete Section III B 1 for
the tributary Section III B 2 for any onsite wetlands and Section III B 3 for all wetlands adjacent to that tributary both onsite
and offsite The determination whether a significant nexus exists is determined in Section III C below
1 Characteristics of non TNWs that flow directly or indirectly into TNW
(i) General Area Conditions
Watershed size 20 square
Drainage area 15 acresl--u
Average annual rainfall 42 inches
Average annual snowfall 10 inches
(n) Physical Characteristics
(a) Relationship with TNW
❑ Tributary flows directly into TNW
® Tributary flows through 3 tributaries before entering TNW
Project waters are 30 (or more river miles from TNW
Project waters are 1 (or less) river miles from RPW
Project waters are 30 (or more) aerial (straight) miles from TNW
Project waters are 1_(2r less) aerial (straight) miles from RPW
Project waters cross or serve as state boundaries Explain
Identify flow route to TNW5 UT to West Fork Deep River West Fork Deep River Deep River Cape Fear River
Tributary stream order if known I"
Note that the Instructional Guidebook contains additional information regarding swales ditches washes and erosional features generally and in the and
West
s Flow route can be described by identifying e g tributary a which flows through the review area, to flow into tributary b which then flows into TNW

(b) General Tnbutary Characteristics (check all that apply)
Tributary is ® Natural
❑ Artificial (man made) Explain
❑ Manipulated (man altered) Explain
Tributary properties with respect to top of bank (estimate)
Average width 3 feet
Average depth 2 5 feet
Average side slopes 1
Primary tributary substrate composition (check all that apply)
® Silts ® Sands
® Cobbles ® Gravel
❑ Bedrock ❑ Vegetation Type // cover
❑ Other Explain
❑ Concrete
❑ Muck
Tributary condition/stability [e g highly eroding sloughing banks] Explain stable channel
Presence of run/nf le /pool complexes Explain moderate
Tributary geometry Meandering
Tributary gradient (approximate average slope) 0 2 /
(c) Flow
Tributary provides for Seaso lan flow
Estimate average number of flow events in review area/year 20 (or greater)
Describe flow regime Weak flow at time of field visit
Other information on duration and volume
Surface flow is Co f enn ii d Characteristics
Subsurface flow lUnkn wo o Explain findings
❑ Dye (or other) test performed
Tributary has (check all that apply)
® Bed and banks
® OHWM6 (check all indicators that apply)
® clear natural line impressed on the bank
❑
® changes in the character of soil
❑
❑ shelving
® vegetation matted down bent or absent
® leaf litter disturbed or washed away
❑
® sediment deposition
❑
❑ water staining
❑
❑ other (list)
❑ Discontinuous OHWM 7 Explain
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
If factors other than the OHWM were used to determine lateral extent of CWA jurisdiction (check all that apply)
❑ High Tide Line indicated by ❑ Mean High Water Mark indicated by
❑ oil or scum line along shore objects ❑ survey to available datum
❑ fine shell or debris deposits (foreshore) ❑ physical markings
❑ physical markings /characteristics ❑ vegetation lines /changes in vegetation types
❑ tidal gauges
❑ other (list)
(iii) Chemical Characteristics
Characterize tributary (e g water color is clear discolored oily film water quality general watershed characteristics etc )
Explain water color is clear
Identify specific pollutants if known possible nutrient loading from surrounding residential area
(A natural or man made discontinuity in the OHWM does not necessarily sever jurisdiction (e g where the stream temporarily flows underground or where
the OHWM has been removed by development or agricultural practices) Where there is a break in the OHWM that is unrelated to the waterbody s flow
regime (e g flow over a rock outcrop or through a culvert) the agencies will look for indicators of flow above and below the break
'Ibid

(iv) Biological Characteristics Channel supports (check all that apply)
® Riparian corridor Characteristics (type average width) Forested 50 feet
❑ Wetland fringe Characteristics
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish /spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
2 Characteristics of wetlands adjacent to non TNW that flow directly or indirectly into TNW
(i) Physical Characteristics
(a) General Wetland Characteristics
Properties
Wetland size acres
Wetland type Explain
Wetland quality Explain
Project wetlands cross or serve as state boundanes Explain
(b) General Flow Relationship with Non TNW
Flow is Pick List Explain
Surface flow is Pick L►stList
Charactenstics
Subsurface flow Pick List Explain findings
❑ Dye (or other) test performed
(c) Wetland Adlacencv Determination with Non TNW
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection Explain
❑ Ecological connection Explain
❑ Separated by berm/bamer Explain
(d) Proximity (Relationship) to TNW
Project wetlands are Pick Listt river miles from TNW
Project waters are Pick List aenal (straight) miles from TNW
Flow is from Pick List.
Estimate approximate location of wetland as within the Pick L►stList floodplam
(u) Chemical Characteristics
Characterize wetland system (e g water color is clear brown oil film on surface water quality general watershed
characteristics etc ) Explain
Identify specific pollutants if known
(u►) Biological Characteristics Wetland supports (check all that apply)
❑ Riparian buffer Characteristics (type average width)
❑ Vegetation type /percent cover Explain
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish/spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
3 Characteristics of all wetlands adjacent to the tributary (►f any)
All wetland(s) being considered in the cumulative analysis Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis

For each wetland specify the following
Directly abuts9 (YIN) Size (in acres) Directly abuts9 (Y/N) Size (in acres)
Summarize overall biological chemical and physical functions being performed
C SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical physical and biological integrity
of a TNW For each of the following situations a significant nexus exists if the tributary in combination with all of its adjacent
wetlands has more than a speculative or insubstantial effect on the chemical physical and/or biological integrity of a TNW
Considerations when evaluating significant nexus include but are not limited to the volume duration and frequency of the flow
of water in the tributary and its proximity to a TNW and the functions performed by the tributary and all its adjacent
wetlands It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e g between a
tributary and its adjacent wetland or between a tributary and the TNW) Similarly the fact an adjacent wetland lies within or
outside of a floodplam is not solely determinative of significant nexus
Draw connections between the features documented and the effects on the TNW as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook Factors to consider include for example
Does the tributary in combination with its adjacent wetlands (if any) have the capacity to carry pollutants or flood waters to
TNWs or to reduce the amount of pollutants or flood waters reaching a TNW9
Does the tributary in combination with its adjacent wetlands (if any) provide habitat and lifecycle support functions for fish and
other species such as feeding nesting spawning or rearing young for species that are present in the TNW9
Does the tributary in combination with its adjacent wetlands (if any) have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs9
Does the tributary in combination with its adjacent wetlands (if any) have other relationships to the physical chemical or
biological integrity of the TNW9
Note the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below
Significant nexus findings for non RPW that has no adjacent wetlands and flows directly or indirectly into TNWs Explain
findings of presence or absence of significant nexus below based on the tributary itself then go to Section III D
Significant nexus findings for non RPW and its adjacent wetlands where the non RPW flows directly or indirectly into
TNWs Explain findings of presence or absence of significant nexus below based on the tributary in combination with all of its
adjacent wetlands then go to Section III D
3 Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW Explain findings of
presence or absence of significant nexus below based on the tributary in combination with all of its adjacent wetlands then go to
Section III D
D DETERMINATIONS OF JURISDICTIONAL FINDINGS THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY)
1 TNWs and Adjacent Wetlands Check all that apply and provide size estimates in review area
❑ TNWs linear feet width (ft) Or acres
❑ Wetlands adjacent to TNWs acres
RPWs that flow directly or indirectly into TNWs
❑ Tributaries of TNWs where tributaries typically flow year round are jurisdictional Provide data and rationale indicating that
tributary is perennial
® Tributaries of TNW where tributaries have continuous flow seasonally (e g typically three months each year) are
jurisdictional Data supporting this conclusion is provided at Section III B Provide rationale indicating that tributary flows
seasonally Good bed and bank and riffle /pool sequence Wrack lines and hydric soils also present

Provide estimates for jurisdictional waters in the review area (check all that apply)
® Tributary waters 8 linear feet 3 ave width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
Non RPWss that flow directly or indirectly into TNWs
❑ Waterbody that is not a TNW or an RPW but flows directly or indirectly into a TNW and it has a significant nexus with a
TNW is junsdictional Data supporting this conclusion is provided at Section III C
Provide estimates for jurisdictional waters within the review area (check all that apply)
❑
Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands
❑ Wetlands directly abutting an RPW where tributaries typically flow year round Provide data and rationale
indicating that tributary is perennial in Section III D 2 above Provide rationale indicating that wetland is
directly abutting an RPW
❑ Wetlands directly abutting an RPW where tributaries typically flow seasonally Provide data indicating that tributary is
seasonal in Section III B and rationale in Section III D 2 above Provide rationale indicating that wetland is directly
abutting an RPW
Provide acreage estimates for jurisdictional wetlands in the review area acres
5 Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs
❑ Wetlands that do not directly abut an RPW but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands have a significant nexus with a TNW are junsidictional Data supporting this
conclusion is provided at Section III C
Provide acreage estimates for junsdictional wetlands in the review area acres
Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to such waters and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands have a significant nexus with a TNW are junsdictional Data supporting this
conclusion is provided at Section III C
Provide estimates for jurisdictional wetlands in the review area acres
7 Impoundments of jurisdictional waters 9
As a general rule the impoundment of a jurisdictional tributary remains jurisdictional
❑ Demonstrate that impoundment was created from `waters of the U S or
❑ Demonstrate that water meets the criteria for one of the categories presented above (1 6) or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below)
ISOLATED [INTERSTATE OR INTRA STATE] WATERS INCLUDING ISOLATED WETLANDS THE USE
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY) io
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce
❑ which are or could be used for industnal purposes by mdustnes in interstate commerce
❑ Interstate isolated waters Explain
❑ Other factors Explain
Identify water body and summarize rationale supporting determination
See Footnote # 3
9 To complete the analysis refer to the key in Section III D 6 of the instructional Guidebook
10 Prior to asserting or declining CWA jurisdiction based solely on this category Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdichon Following Rapanos

Provide estimates for jurisdictional waters in the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
❑ Wetlands acres
F NON JURISDICTIONAL WATERS INCLUDING WETLANDS (CHECK ALL THAT APPLY)
❑ If potential wetlands were assessed within the review area these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements
❑ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce
❑ Prior to the Jan 2001 Supreme Court decision in SWANCC the review area would have been regulated based solely on the
Migratory Bud Rule (MBR)
❑ Waters do not meet the Significant Nexus standard where such a finding is required for.junsdiction Explain
❑ Other (explain if not covered above)
Provide acreage estimates for non .jurisdictional waters in the review area, where the sole potential basis of_junsdiction is the MBR
factors (i e presence of migratory birds presence of endangered species use of water for irrigated agriculture) using best professional
,judgment (check all that apply)
❑ Non wetland waters (i a rivers streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List type of aquatic resource
❑ Wetlands acres
Provide acreage estimates for non .jurisdictional waters in the review area that do not meet the Significant Nexus standard where such
a finding is required for_junsdiction (check all that apply)
❑ Non wetland waters (i e rivers streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List type of aquatic resource
❑ Wetlands acres
SECTION IV DATA SOURCES
A SUPPORTING DATA Data reviewed for JD (check all that apply checked items shall be included in case file and where checked
and requested appropriately reference sources below)
Maps plans plots or plat submitted by or on behalf of the applicant/consultant
® Data sheets prepared /submitted by or on behalf of the applicant/consultant
❑ Office concurs with data sheets /delineation report
❑ Office does not concur with data sheets /delineation report
❑ Data sheets prepared by the Corps
❑ Corps navigable waters study
U S Geological Survey Hydrologic Atlas
❑ USGS NHD data
® USGS 8 and 12 digit HUC maps
® U S Geological Survey map(s) Cite scale & quad name 1 24 000 High Point East
® USDA Natural Resources Conservation Service Soil Survey Citation Soil Survey for Guilford County NC
❑ National wetlands inventory map(s) Cite name
❑ State/Local wetland inventory map(s)
❑ FEMA/FIRM maps
❑ 100 year Floodplam Elevation is (National Geodectic Vertical Datum of 1929)
® Photographs ® Aerial (Name & Date) 2010 DigrtalGlobe
or ❑ Other (Name & Date)
❑ Previous determination(s) File no and date of response letter
❑ Applicable /supporting case law
❑ Applicable /supporting scientific literature
❑ Other information (please specify)
B ADDITIONAL COMMENTS TO SUPPORT JD This form represents intermittent SB

WA WB SC SWA
APPROVED JURISDICTIONAL DETERMINATION FORM
U S Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook
SECTION I BACKGROUND INFORMATION
A REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD)
B DISTRICT OFFICE FILE NAME AND NUMBER
C PROJECT LOCATION AND BACKGROUND INFORMATION NC 68 / NC 311 Interchange STIP U 5169 Evaluator ]Benton
State NC County /parish/borough Guilford City High Point
Center coordinates of site (lat/long in degree decimal format) Lat 36 00440 N Long 79 99559 L
Universal Transverse Mercator 17S 590521 3984902
Name of nearest waterbody West Fork Deep River (Oak Hollow Reservoir)
Name of nearest Traditional Navigable Water (TNW) Into which the aquatic resource flows Cape Fear River
Name of watershed or Hydrologic Unit Code (HUC) Deep 03030003
® Check if map /diagram of review area and/or potential Jurisdictional areas is /are available upon request
❑ Check if other sites (e g offsite mitigation sites disposal sites etc ) are associated with this action and are recorded on a
different JD form
D REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY)
❑ Office (Desk) Determination Date
❑ Field Determination Date(s)
SECTION H SUMMARY OF FINDINGS
A RHA SECTION 10 DETERMINATION OF JURISDICTION
There Ar no navigable waters of the US within Rivers and Harbors Act (RHA) Junsdiction (as defined by 33 CFR part 329) in the
review area [Required]
❑ Waters subject to the ebb and flow of the tide
❑ Waters are presently used or have been used in the past or may be susceptible for use to transport interstate or foreign commerce
Explain
B CWA SECTION 404 DETERMINATION OF JURISDICTION
There Are waters of the U S within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area [Required]
1 Waters of the U S
a Indicate presence of waters of US in review area (check all that apply) i
❑ TNWs including territorial seas
❑ Wetlands adjacent to TNWs
Z Relatively permanent waterS2 (RPWs) that flow directly or indirectly into TNWs
❑ Non RPWs that flow directly or indirectly into TNWs
® Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
® Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
® Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters including isolated wetlands
b Identify (estimate) size of waters of the U S in the review area
Non wetland waters 272 linear feet 4 width (ft) and/or 0 12 impounded surface water (SWA) acres
Wetlands 0 16 acres
c Limits (boundaries) of jurisdiction based on 4987 Delineation Manual
Elevation of established OHWM (if known)
2 Non regulated waters/wetlands (check if applicable) 3
❑ Potentially jurisdictional waters and /or wetlands were assessed within the review area and determined to be not jurisdictional
Explain
i Boxes checked below shall be supported by completing the appropriate sections in Section III below
2 For purposes of this form an RPW is defined as a tributary that is not a TNW and that typically flows year round or has continuous flow at least seasonally
(e g typically 3 months)
3 Supporting documentation is presented in Section IIi F

SECTION III CWA ANALYSIS
A TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs If the aquatic resource is a TNW complete
Section III A 1 and Section III D 1 only if the aquatic resource is a wetland adjacent to a TNW complete Sections III A 1 and 2
and Section III D 1 otherwise see Section III B below
1 TNW
Identify TNW
Summarize rationale supporting determination
2 Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is adjacent
B CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY)
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands if any and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met
The agencies will assert jurisdiction over non navigable tributaries of TNWs where the tributaries are relatively permanent
waters (RPWs) i e tributaries that typically flow year round or have continuous flow at least seasonally (e g typically 3
months) A wetland that directly abuts an RPW is also jurisdictional If the aquatic resource is not a TNW but has year round
(perennial) flow skip to Section III D 2 If the aquatic resource is a wetland directly abutting a tributary with perennial flow
skip to Section III D 4
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water even
though a significant nexus finding is not required as a matter of law
If the waterbody° is not an RPW or a wetland directly abutting an RPW a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW If the tributary has adjacent wetlands the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands This significant nexus evaluation that combines for
analytical purposes the tributary and all of its adjacent wetlands is used whether the review area idenhfied in the JD request is
the tributary or its adjacent wetlands or both If the JD covers a tributary with adjacent wetlands complete Section III B 1 for
the tributary Section III B 2 for any ons►te wetlands and Section III B 3 for all wetlands adjacent to that tributary both onsite
and offsite The determination whether a significant nexus exists is determined in Section III C below
1 Characteristics of non TNWs that flow directly or indirectly into TNW
(i) General Area Conditions
Watershed size Pick List
Drainage area rpick List
Average annual rainfall inches
Average annual snowfall inches
(u) Physical Characteristics
(a) Relationship with TNW
❑ Tributary flows directly into TNW
❑ Tributary flows through Pick List tributaries before entering TNW
Project waters are P►ck L►stList river miles from TNW
Project waters are Pick List river miles from RPW
Project waters are Pick List aerial (straight) miles from TNW
Project waters are Pick List aerial (straight) miles from RPW
Project waters cross or serve as state boundaries Explain
Identify flow route to TNW5
Tributary stream order if known
° Note that the Instructional Guidebook contains additional information regarding swales ditches washes and erosional features generally and in the and
West
5 Flow route can be described by identifying e g tributary a which flows through the review area to flow into tributary b which then flows into TNW

(b) General Tributary Characteristics (check all that apply)
Tributary is ❑ Natural
❑ Artificial (man made) Explain
❑ Manipulated (man altered) Explain
Tributary properties with respect to top of bank (estimate)
Average width feet
Average depth feet
Average side slopes Pick List
Primary tributary substrate composition (check all that apply)
❑ Silts ❑ Sands
❑ Cobbles ❑ Gravel
❑ Bedrock ❑ Vegetation Type // cover
❑ Other Explain
❑ Concrete
❑ Muck
Tributary condition/stability [e g highly eroding sloughing banks] Explain
Presence of run/nffle /pool complexes Explain
Tributary geometry Pick List
Tributary gradient (approximate average slope) °/
(c) Flow
Tributary provides for iP►ck List
Estimate average number of flow events in review area/year Pic k t
Describe flow regime
Other information on duration and volume
Surface flow is Pick List Characteristics
Subsurface flow Pick List Explain findings
❑ Dye (or other) test performed
Tributary has (check all that apply)
❑ Bed and banks
❑ OHWM6 (check all indicators that apply)
❑ clear natural line impressed on the bank
❑
❑ changes in the character of soil
❑
❑ shelving
❑
❑ vegetation matted down bent or absent
❑
❑ leaf litter disturbed or washed away
❑
❑ sediment deposition
❑
❑ water staining
❑
❑ other (list)
❑ Discontinuous OHWM 7 Explain
If factors other than the OHWM were used to determ
❑ High Tide Line indicated by ❑
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical markings /charactenstics
❑ tidal gauges
❑ other (list)
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
me lateral extent of CWA junsdictron (check all that apply)
Mean High Water Mark indicated by
❑ survey to available datum
❑ physical markings
❑ vegetation lines /changes in vegetation types
(iii) Chemical Characteristics
Characterize tributary (e g water color is clear discolored oily film water quality general watershed characteristics etc )
Explain
Identify specific pollutants if known
6A natural or man made discontinuity in the OHWM does not necessarily sever jurisdiction (e g where the stream temporarily flows underground or where
the OHWM has been removed by development or agricultural practices) Where there is a break in the OHWM that is unrelated to the waterbody s flow
regime (e g flow over a rock outcrop or through a culvert) the agencies wil l look for indicators of flow above and below the break
lbid

(w) Biological Characteristics Channel supports (check all that apply)
❑ Riparian corridor Characteristics (type average width)
❑ Wetland fnnge Characteristics
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish/spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
2 Characteristics of wetlands adjacent to non TNW that flow directly or indirectly into TNW
(i) Physical Characteristics
(a) General Wetland Characteristics
Properties
Wetland size 0 Olacres
Wetland type Explain Palustnne scrub /shrub
Wetland quality Explain NCDWQ wetland rating 13
Project wetlands cross or serve as state boundanes Explain
(b) General Flow Relationship with Non TNW
Flow is fn�termittent Explain culvert conveyance
Surface flow is Co fCo
Charactenstics
Subsurface flow UuT known Explain findings
❑ Dye (or other) test performed
(c) Wetland Adjacency Determination with Non TNW
❑ Directly abutting
® Not directly abutting
® Discrete wetland hydrologic connection Explain culvert
❑ Ecological connection Explain
❑ Separated by benn/barrier Explain
(d) Proximity (Relationship) to TNW
Project wetlands are 30 (or —m river miles from TNW
Project waters are 30 (or more) aenal (straight) miles from TNW
Flow is from Wetland to navigabl to ewers
Estimate approximate location of wetland as within the - or greater, floodplain
(n) Chemical Characteristics
Characterize wetland system (e g water color is clear brown oil film on surface water quality general watershed
characteristics etc ) Explain water color is clear
Identify specific pollutants if known
(in) Biological Characteristics Wetland supports (check all that apply)
® Riparian buffer Characteristics (type average width) grassy 20 feet
® Vegetation type /percent cover Explain scrub /shrub 50 percent
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish/spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
3 Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis

For each wetland specify the following
Directly abuts9 (Y/N) Size (in acres) Directly abuts9 (Y/N) Size (in acres)
Summarize overall biological chemical and physical functions being performed
C SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tnbutary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical physical and biological integrity
of a TNW For each of the following situations a significant nexus exists if the tnbutary in combination with all of its adjacent
wetlands has more than a speculative or insubstantial effect on the chemical physical and/or biological integrity of a TNW
Considerations when evaluating significant nexus include but are not limited to the volume duration and frequency of the flow
of water in the tnbutary and its proximity to a TNW and the functions performed by the tnbutary and all its adjacent
wetlands It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e g between a
tnbutary and its adjacent wetland or between a tnbutary and the TNW) Similarly the fact an adjacent wetland Tres within or
outside of a floodplam is not solely determinative of significant nexus
Draw connections between the features documented and the effects on the TNW as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include for example
Does the tributary in combination with its adjacent wetlands (if any) have the capacity to carry pollutants or flood waters to
TNWs or to reduce the amount of pollutants or flood waters reaching a TNW9
Does the tnbutary in combination with its adjacent wetlands (if any) provide habitat and lifecycle support functions for fish and
other species such as feeding nesting spawning or rearing young for species that are present in the TNW9
Does the tributary in combination with its adjacent wetlands (if any) have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs9
Does the tributary in combination with its adjacent wetlands (if any) have other relationships to the physical chemical or
biological mtegnty of the TNW9
Note the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below
Significant nexus findings for non RPW that has no adjacent wetlands and flows directly or indirectly into TNWs Explain
findings of presence or absence of significant nexus below based on the tnbutary itself then go to Section III D
Significant nexus findings for non RPW and its adjacent wetlands where the non RPW flows directly or indirectly into
TNWs Explain findings of presence or absence of significant nexus below based on the tnbutary in combination with all of its
adjacent wetlands then go to Section III D
Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW Explain findings of
presence or absence of significant nexus below based on the tributary in combination with all of its adjacent wetlands then go to
Section 111 D The wetland is hydrologically connected to the RPW through a culvert conveyance
D DETERMINATIONS OF JURISDICTIONAL FINDINGS THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY)
1 TNWs and Adjacent Wetlands Check all that apply and provide size estimates in review area
❑ TNWs linear feet width (ft) Or acres
❑ Wetlands adjacent to TNWs acres
RPWs that flow directly or indirectly into TNWs
® Tributaries of TNWs where tributaries typically flow year round are jurisdictional Provide data and rationale indicating that
tributary is perennial Moderate to strong geomorphologic hydrologic and biologic indicators present during field visit
❑ Tributaries of TNW where tnbutanes have continuous flow seasonally (e g typically three months each year) are
jurisdictional Data supporting this conclusion is provided at Section III B Provide rationale indicating that tnbutary flows
seasonally Good bed and bank sinuosity riffle pool and substrate sorting Moderate flow Hydnc soils also present

Provide estimates for junsdictional waters in the review area (check all that apply)
® Tributary waters 272 linear feet 4 width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
Non RPWss that flow directly or indirectly mto TNWs
❑ Waterbody that is not a TNW or an RPW but flows directly or indirectly into a TNW and it has a significant nexus with a
TNW islunsdictional Data supporting this conclusion is provided at Section IiI C
Provide estimates forjunsdictional waters within the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs
® Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands
® Wetlands directly abutting an RPW where tributaries typically flow year round Provide data and rationale
indicating that tnbutary is perennial in Section III D 2 above Provide rationale indicating that wetland is
directly abutting an RPW The wetland is hydrologically connected to the RPW therefore it is ,jurisdictional
❑ Wetlands directly abutting an RPW where tributaries typically flow seasonally Provide data indicating that tributary is
seasonal in Section III B and rationale in Section III D 2 above Provide rationale indicating that wetland is directly
abutting an RPW
Provide acreage estimates forjunsdtctional wetlands in the review area 0 15 acres
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs
® Wetlands that do not directly abut an RPW but when considered in combination with the tnbutary to which they are adjacent
and with similarly situated adjacent wetlands have a significant nexus with a TNW are.junsidictional Data supporting this
conclusion is provided at Section III C
Provide acreage estimates forjunsdicttonal wetlands to the review area 0 01 acres
6 Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to such waters and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands have a significant nexus with a TNW are jurisdictional Data supporting this
conclusion is provided at Section III C
Provide estimates for jurisdictional wetlands to the review area acres
7 Impoundments of,junsdictional waters 9
Asa general rule the impoundment of a jurisdictional tributary remains jurisdictional
® Demonstrate that impoundment was created from `waters of the U S or
❑ Demonstrate that water meets the cnterta for one of the categories presented above (1 6) or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below)
ISOLATED [INTERSTATE OR INTRA STATE] WATERS INCLUDING ISOLATED WETLANDS THE USE
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY) to
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce
❑ which are or could be used for industrial purposes by mdustnes in interstate commerce
❑ Interstate isolated waters Explain
❑ Other factors Explain
Identify water body and summarize rationale supporting determination
'See Footnote # 3
' To complete the analysis refer to the key in Section III D 6 of the Instructional Guidebook
10 Prior to asserting or declining CWA,jurisdiction based solely on this category Corps Districts wdl elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdichon Following Rapanos

Provide estimates for Jurisdictional waters in the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
❑ Wetlands acres
F NON JURISDICTIONAL WATERS INCLUDING WETLANDS (CHECK ALL THAT APPLY)
❑ If potential wetlands were assessed within the review area these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements
❑ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce
❑ Prior to the Jan 2001 Supreme Court decision in SWANCC the review area would have been regulated based solely on the
Migratory Bird Rule (MBR)
❑ Waters do not meet the Significant Nexus standard where such a finding is required for Junsdiction Explain
❑ Other (explain if not covered above)
Provide acreage estimates for non Jurisdictional waters in the review area, where the sole potential basis of Jurisdiction is the MBR
factors (i a presence of migratory birds presence of endangered species use of water for irrigated agriculture) using best professional
Judgment (check all that apply)
❑ Non wetland waters (i e rivers streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List type of aquatic resource
❑ Wetlands acres
Provide acreage estimates for non Jurisdictional waters in the review area that do not meet the Significant Nexus standard where such
a finding is required for Junsdiction (check all that apply)
❑ Non wetland waters (i e rivers streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List type of aquatic resource
❑ Wetlands acres
SECTION IV DATA SOURCES
A SUPPORTING DATA Data reviewed for JD (check all that apply checked items shall be included in case file and where checked
and requested appropriately reference sources below)
® Maps plans plots or plat submitted by or on behalf of the applicant/consultant
® Data sheets prepared /submitted by or on behalf of the applicant/consultant
❑ Office concurs with data sheets /delmeation 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 14UC maps
® U S Geological Survey map(s) Cite scale & quad name 1 24 000 Guilford
® USDA Natural Resources Conservation Service Soil Survey Citation Soil Survey for Guilford County NC
❑ National wetlands inventory map(s) Cite name
❑ State/Local wetland inventory map(s)
❑ FEMA/FIRM maps
❑ 100 year Floodplam Elevation is (National Geodectic Vertical Datum of 1929)
® Photographs ® Aerial (Name & Date) 2010 DigitalGlobe
or ❑ Other (Name & Date)
❑ Previous determination(s) File no and date of response letter
❑ Applicable /supporting case law
❑ Applicable /supporting scientific literature
❑ Other information (please specify)
B ADDITIONAL COMMENTS TO SUPPORT JD This form represents wetlands WA and WB perennial SC and surface water SWA

WC
APPROVED JURISDICTIONAL DETERMINATION FORM
U S Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook
SECTION I BACKGROUND INFORMATION
A REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD)
B DISTRICT OFFICE FILE NAME AND NUMBER
C PROJECT LOCATION AND BACKGROUND INFORMATION NC 68 / NC 311 Interchange STIP U 5169 Evaluator ]Benton
State NC County /parish/borough Guilford City High Point
Center coordinates of site (lat/long in degree decimal format) Lat 3600359 N Long 7999158 W
Universal Transverse Mercator 17S 590883 3984817
Name of nearest waterbody West Fork Deep River (Oak Hollow Reservoir)
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows Cape Fear River
Name of watershed or Hydrologic Unit Code (HUC) Deep 03030003
® Check if map /diagram of review area and/or potential Jurisdictional areas is /are available upon request
❑ Check if other sites (e g offsite mitigation sites disposal sites etc ) are associated with this action and are recorded on a
different JD form
D REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY)
❑ Office (Desk) Determination Date
❑ Field Determination Date(s)
SECTION II SUMMARY OF FINDINGS
A RHA SECTION 10 DETERMINATION OF JURISDICTION
There Arr o navigable waters of the US within Rivers and Harbors Act (RHA) Junsdiction (as defined by 33 CFR part 329) in the
review area [Required]
❑ Waters subject to the ebb and flow of the tide
❑ Waters are presently used or have been used in the past or may be susceptible for use to transport interstate or foreign commerce
Explain
B CWA SECTION 404 DETERMINATION OF JURISDICTION
There Are waters of the U S within Clean Water Act (CWA) Jurisdiction (as defined by 33 CFR part 328) in the review area [Required]
1 Waters of the U S
a Indicate presence of waters of U S in review area (check all that apply) i
❑ TNWs including territorial seas
❑ Wetlands adjacent to TNWs
El Relatively permanent watersZ (RPWs) that flow directly or indirectly into TNWs
❑ Non RPWs that flow directly or indirectly into TNWs
❑ Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
® Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
❑ Impoundments of jurisdictional waters
❑ Isolated (interstate or intrastate) waters including isolated wetlands
b Identify (estimate) size of waters of the U S in the review area
Non wetland waters linear feet width (ft) and/or acres
Wetlands 0 01 acres
c Limits (boundaries) of lunsdiction based on 1987 Delineation Manual
Elevation of established OHWM (if known)
2 Non regulated waters/wetlands (check if applicable) 3
❑ Potentially jurisdictional waters and /or wetlands were assessed within the review area and determined to be not junsdictional
Explain
Boxes checked below shall be supported by completing the appropriate sections in Section 111 below
z For purposes of this form an RPW is defined as a tributary that is not a TNW and that typically flows year round or has continuous flow at least seasonally
(e g typically 3 months)
3 Supporting documentation is presented in Section III F

SECTION III CWA ANALYSIS
A TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs If the aquatic resource is a TNW complete
Section III A 1 and Section III D 1 only if the aquatic resource is a wetland adjacent to a TNW complete Sections III A I and 2
and Section III D 1 otherwise see Section III B below
1 TNW
Identify TNW
Summarize rationale supporting determination
Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is adjacent
CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY)
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands if any and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met
The agencies will assert jurisdiction over non navigable tributaries of TNWs where the tributaries are "relatively permanent
waters (RPWs) ► e tributaries that typically flow year round or have continuous flow at least seasonally (e g typically 3
months) A wetland that directly abuts an RPW is also jurisdictional If the aquatic resource is not a TNW but has year round
(perennial) flow skip to Section III D 2 If the aquatic resource is a wetland directly abutting a tributary with perennial flow
skip to Section III D 4
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water even
though a significant nexus finding is not required as a matter of law
If the waterbody4 is not an RPW or a wetland directly abutting an RPW a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW If the tributary has adjacent wetlands the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands This significant nexus evaluation that combines for
analytical purposes the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary or its adjacent wetlands or both If the JD covers a tributary with adjacent wetlands complete Section III B 1 for
the tributary Section III B 2 for any onsite wetlands and Section III B 3 for all wetlands adjacent to that tributary both onsite
and offsite The determination whether a significant nexus exists is determined in Section III C below
1 Characteristics of non TNWs that flow directly or indirectly into TNW
(i) General Area Conditions
Watershed size 30 a erc
Drainage area 15 r cres
Average annual rainfall 42 inches
Average annual snowfall 10 inches
(u) Physical Characteristics
(a) Relationship with TNW
❑ Tributary flows directly into TNW
® Tributary flows through 3 tributaries before entering TNW
Project waters are 30 (or more) river miles from TNW
Project waters are 1 (or less) river miles from RPW
Project waters are 30 (or more) aerial (straight) miles from TNW
Project waters are 1 (or less) aerial (straight) miles from RPW
Project waters cross or serve as state boundaries Explain
Identify flow route to TNW5 UT to West Fork Deep River West Fork Deep River Deep River Cape Fear River
Tributary stream order if known 1 i
Note that the Instructional Guidebook contains additional information regarding swales ditches washes and erosional features generally and in the and
West
s Flow route can be described by identifying e g tributary a which flows through the review area to flow into tributary b which then flows into TNW

(b) General Tributary Characteristics (check all that apply)
Tributary is ® Natural
❑ Artificial (man made) Explain
❑ Manipulated (man altered) Explain
Tributary properties with respect to top of bank (estimate)
Average width 3 feet
Average depth 2 5 feet
Average side slopes 1
Primary tributary substrate composition (check all that apply)
❑ Silts ® Sands
® Cobbles ® Gravel
❑ Bedrock ❑ Vegetation Type // cover
❑ Other Explain
❑ Concrete
❑ Muck
Tributary condition/stability [e g highly eroding sloughing banks] Explain channel is stable
Presence of run/nffle /pool complexes Explain weak riffle pool
Tributary geometry Meand riene rig
Tributary gradient (approximate average slope) 0 2 /
(c) Flow
Tributary provides for Season
Estimate average number of flow events in review area/year 20 (or greater)
Describe flow regime weak flow
Other information on duration and volume
Surface flow is Confined Characteristics
Subsurface flow Unk wo nwo n Explain findings
❑ Dye (or other) test performed
Tributary has (check all that apply)
® Bed and banks
® OHWM6 (check all indicators that apply)
® clear natural line impressed on the bank
® changes in the character of soil
❑
❑ shelving
® vegetation matted down bent or absent
❑ leaf litter disturbed or washed away
❑
® sediment deposition
❑
® water staining
❑
❑ other (list)
❑ Discontinuous OHWM 7 Explain
If factors other than the OHWM were used to determ
❑ High Tide Line indicated by ❑
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical markings /charactenstics
❑ tidal gauges
❑ other (list)
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
me lateral extent of CWA jurisdiction (check all that apply)
Mean High Water Mark indicated by
❑ survey to available datum
❑ physical markings
❑ vegetation lines /changes in vegetation types
(iii) Chemical Characteristics
Characterize tributary (e g water color is clear discolored oily film water quality general watershed characteristics etc )
Explain water color is clear
Identify specific pollutants if known
6A natural or man made discontinuity in the OHWM does not necessarily sever jurisdiction (e g where the stream temporarily flows underground or where
the OHWM has been removed by development or agricultural practices) Where there is a break in the OHWM that is unrelated to the waterbody s flow
regime (e g flow over a rock outcrop or through a culvert) the agencies will look for indicators of flow above and below the break
Ibid

(w) Biological Characteristics Channel supports (check all that apply)
® Riparian corridor Characteristics (type average width) forested 100 feet
❑ Wetland fringe Characteristics
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish/spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
2 Characteristics of wetlands adjacent to non TNW that flow directly or indirectly into TNW
(i) Physical Characteristics
(a) General Wetland Characteristics
Properties
Wetland size 0 Olacres
Wetland type Explain Palustnne forested
Wetland quality Explain NCDWQ wetland rating 19
Project wetlands cross or serve as state boundaries Explain
(b) General Flow Relationship with Non TNW
Flow is Ephem a ral 'fl w Explain culvert conveyance
Surface flow is Co f en nn d
Characteristics
Subsurface flow Unknown Explain findings
❑ Dye (or other) test performed
(c) Wetland Adjacency Determination with Non TNW
❑ Directly abutting
® Not directly abutting
® Discrete wetland hydrologic connection Explain ephemeral channels
❑ Ecological connection Explain
❑ Separated by berm/bamer Explain
(d) Proximity (Relationship)to TNW
Project wetlands are 30 (o ormr river miles from TNW
Project waters are 30 (or more) aenal (straight) miles from TNW
Flow is from Wetland to naviga teae wabl rs
Estimate approximate location of wetland as within the 500 yea or greater, floodplam
(n) Chemical Characteristics
Characterize wetland system (e g water color is clear brown oil film on surface water quality general watershed
characteristics etc ) Explain
Identify specific pollutants if known
(iii) Biological Characteristics Wetland supports (check all that apply)
® Riparian buffer Charactenstics (type average width) forested 50 feet
® Vegetation type /percent cover Explain forested 75 percent scrub /shrub 70 percent
❑ Habitat for
❑ Federally Listed species Explain findings
❑ Fish/spawn areas Explain findings
❑ Other environmentally sensitive species Explain findings
❑ Aquatic /wildlife diversity Explain findings
3 Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis 3Pick List
Approximately ( ) acres in total are being considered in the cumulative analysis

For each wetland specify the following
Directly abuts9 (Y/N) Size (in acres) Directly abuts9 (Y/N) Size (in acres)
Summarize overall biological chemical and physical functions being performed
C SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical physical and biological integrity
of a TNW For each of the following situations a significant nexus exists if the tributary in combination with all of its adjacent
wetlands has more than a speculative or insubstantial effect on the chemical physical and/or biological integrity of a TNW
Considerations when evaluating significant nexus include but are not limited to the volume duration and frequency of the flow
of water in the tributary and its proximity to a TNW and the functions performed by the tributary and all its adjacent
wetlands It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e g between a
tributary and its adjacent wetland or between a tributary and the TNW) Similarly the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus
Draw connections between the features documented and the effects on the TNW as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook Factors to consider include for example
Does the tributary in combination with its adjacent wetlands (if any) have the capacity to carry pollutants or flood waters to
TNWs or to reduce the amount of pollutants or flood waters reaching a TNW?
Does the tributary in combination with its adjacent wetlands (if any) provide habitat and lifecycle support functions for fish and
other species such as feeding nesting spawning or rearing young for species that are present in the TNW?
Does the tributary in combination with its adjacent wetlands (if any) have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
Does the tributary in combination with its adjacent wetlands (if any) have other relationships to the physical chemical or
biological integrity of the TNW?
Note the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below
1 Significant nexus findings for non RPW that has no adjacent wetlands and flows directly or indirectly into TNWs Explain
findings of presence or absence of significant nexus below based on the tributary itself then go to Section III D
2 Significant nexus findings for non RPW and its adjacent wetlands where the non RPW flows directly or indirectly into
TNWs Explain findings of presence or absence of significant nexus below based on the tributary in combination with all of its
adjacent wetlands then go to Section III D
3 Significant nexus findings for wetlands adjacent to an RPW but that do not directly abut the RPW Explain findings of
presence or absence of significant nexus below based on the tributary in combination with all of its adjacent wetlands then go to
Section III D The wetland is hydrologically connected to the RPW through ephemeral channels
D DETERMINATIONS OF JURISDICTIONAL FINDINGS THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY)
1 TNWs and Adjacent Wetlands Check all that apply and provide size estimates in review area
❑ TNWs linear feet width (ft) Or acres
❑ Wetlands adjacent to TNWs acres
2 RPWs that flow directly or indirectly into TNWs
❑ Tributaries of TNWs where tributaries typically flow year round arejunsdictional Provide data and rationale indicating that
tributary is perennial Moderate to strong geomorphologic hydrologic and biologic indicators present during field visit
❑ Tributaries of TNW where tributaries have continuous flow seasonally (e g typically three months each year) are
jurisdictional Data supporting this conclusion is provided at Section III B Provide rationale indicating that tributary flows
seasonally

Provide estimates for jurisdictional waters in the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
Non RPWss that flow directly or indirectly into TNWs
❑ Waterbody that is not a TNW or an RPW but flows directly or indirectly into a TNW and it has a significant nexus with a
TNW is jurisdictional Data supporting this conclusion is provided at Section III C
Provide estimates for jurisdictional Aaters within the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
Wetlands directly abutting an RPW that flow directly or indirectly into TNWs
❑ Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands
❑ Wetlands directly abutting an RPW where tributanes typically flow year round Provide data and rationale
indicating that tnbutary is perennial in Section III D 2 above Provide rationale indicating that wetland is
directly abutting an RPW
❑ Wetlands directly abutting an RPW where tributaries typically flow seasonally Provide data indicating that tnbutary is
seasonal in Section III B and rationale in Section III D 2 above Provide rationale indicating that wetland is directly
abutting an RPW
Provide acreage estimates for jurisdictional wetlands in the review area acres
Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs
® Wetlands that do not directly abut an RPW but when considered in combination with the tnbutary to which they are adjacent
and with similarly situated adjacent wetlands have a significant nexus with a TNW are junsidictional Data supporting this
conclusion is provided at Section III C
Provide acreage estimates for junsdictional wetlands in the review area 0 01 acres
Wetlands adjacent to non RPWs that flow directly or indirectly into TNWs
❑ Wetlands adjacent to such waters and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands have a significant nexus with a TNW are jurisdictional Data supporting this
conclusion is provided at Section III C
Provide estimates for jurisdictional wetlands in the review area acres
7 Impoundments of jurisdictional waters 9
As a general rule the impoundment of a jurisdictional tributary remains jurisdictional
❑ Demonstrate that impoundment was created from `waters of the U S or
❑ Demonstrate that water meets the cntena for one of the categories presented above (1 6) or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below)
ISOLATED [INTERSTATE OR INTRA STATE] WATERS INCLUDING ISOLATED WETLANDS THE USE
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY) io
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce
❑ which are or could be used for industrial purposes by mdustnes in interstate commerce
❑ Interstate isolated waters Explain
❑ Other factors Explain
Identify water body and summarize rationale supporting determination
'See Footnote # 3
9 To complete the analysis refer to the key in Section III D 6 of the Instructional Guidebook
10 Prior to asserting or declining CWA junsdiction based solely on this category Corps Distncts wdl elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps/EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos

Provide estimates for Jurisdictional waters in the review area (check all that apply)
❑ Tributary waters linear feet width (ft)
❑ Other non wetland waters acres
Identify type(s) of waters
❑ Wetlands acres
F NON4URISDICTIONAL WATERS INCLUDING WETLANDS (CHECK ALL THAT APPLY)
❑ If potential wetlands were assessed within the review area these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and/or appropriate Regional Supplements
❑_ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce
❑ Prior to the Jan 2001 Supreme Court decision in SWANCC the review area would have been regulated based solely on the
Migratory Bird Rule (MBR)
❑ Waters do not meet the Significant Nexus standard where such a finding is required for Jurisdiction Explain
❑ Other (explain if not covered above)
Provide acreage estimates for non Jurisdictional waters in the review area, where the sole potential basis of Jurisdiction is the MBR
factors (i a presence of migratory birds presence of endangered species use of water for irrigated agriculture) using best professional
Judgment (check all that apply)
❑ Non wetland waters (i e rivers streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List type of aquatic resource
❑ Wetlands acres
Provide acreage estimates for non Jurisdictional waters in the review area that do not meet the Significant Nexus standard where such
a finding is required for Jurisdiction (check all that apply)
❑ Non wetland waters (i a rivers streams) linear feet width (ft)
❑ Lakes /ponds acres
❑ Other non wetland waters acres List type of aquatic resource
❑ Wetlands acres
SECTION IV DATA SOURCES
A SUPPORTING DATA Data reviewed for JD (check all that apply checked items shall be included in case file and where checked
and requested appropriately reference sources below)
® Maps plans plots or plat submitted by or on behalf of the applicant/consultant
Data sheets prepared/submitted by or on behalf of the applicant/consultant
❑ Office concurs with data sheets /delineation report
❑ Office does not concur with data sheets /delineation report
❑ Data sheets prepared by the Corps
❑ Corps navigable waters study
® U S Geological Survey Hydrologic Atlas
❑ USGS N14D data
® USGS 8 and 12 digit RUC maps
U S Geological Survey map(s) Cite scale & quad name 124 000 Guilford
® USDA Natural Resources Conservation Service Soil Survey Citation Soil Survey for Guilford County NC
❑ National wetlands inventory map(s) Cite name
❑ State/Local wetland inventory map(s)
❑ FEMA /FIRM maps
❑ 100 year Floodplam Elevation is (National Geodectic Vertical Datum of 1929)
® Photographs ® Aerial (Name & Date) 2010 DigrtalGlobe
or ❑ Other (Name & Date)
❑ Previous determination(s) File no and date of response letter
❑ Applicable /supporting case law
❑ Applicable /supporting scientific literature
❑ Other information (please specify)
B ADDITIONAL COMMENTS TO SUPPORT JD This form represents wetland WC