20121101 Ver 1_Complete File_20121206

WAYNE COUNTY, NORTH CAROLINA - SHEET NUMBI

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Name: SOUTHEAST GOLDSBORO
Location: 035° 21'06.6" N 077° 55'55.1411 W
Date: 12/11/2012
Caption: Seymour Memorial Park -East, Goldsboro, Wayne Co.
Scale: 1 inch equals 1000 feet
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NC DWn Stream Tdonfifeatinn Fnrm Vo-o - 4 11
Date:
ProjecVSite: `
Latitude:
Evaluator:
County:
Longitude:
Total Points:
1
2
Stream is at least intermittent
Stream Determination (circle one)
Other
if z 19 or perennial if a 30*
Ephemeral Intermittent Perennial
e.g. Quad Name:
A. Geomorphology (Subtotal = '< " -'' )
Absent
Weak
Moderate
Strong
1 a. Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
C"
1
2
3
3. In- channel structure: ex. riffle -pool, step -pool,
ripple-pool sequence
i�.hff
1
2
3
4. Particle size of stream substrate
0..''
1
2
3
5. Active /relict floodplain
0.
1
2
3
6. Depositional bars or benches
0
1
2
3
7. Recent alluvial deposits
0 ;'
1
2
3
8. Headcuts
0 ,,
1
2
3
9. Grade control
`0'9
0.5
1
1.5
10. Natural valley
0`
0.5
1
1.5
111. Second or greater order channel
No= 0 ')
Yes = 3
aninciai ancnes are not ratea; see aiscussions in manual i
B. Hvdroloov (Subtotal =
12. Presence of Baseflow
0
1
2
3
13. Iron oxidizing bacteria
19. Rooted upland plants in streambed
1
2
3
14. Leaf litter
1.5
1
0.5
0 a
15. Sediment on plants or debris
2
0.5
1
1.5
16. Organic debris lines or piles
0..''
0.5
1
1.5
17. Soil -based evidence of high water table?
No= 0 .
Yes = 3
l+. bimoQV (Subtotal = 1
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos (note diversity and abundance)
0
1
2
3
21. Aquatic Mollusks
0
1
2
3
22. Fish
0
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians
0
0.5
1
1.5
25. Algae
0
0.5
1
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5
Other = 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:
1

C X �R�SS
RECEIVED
DEC - 6 2012
/1;4- NO I
Beverly Perdue, Governor
Dee Freeman., Secretary
North Carolina Department of Environment and Natural Resources
Colleen Sullins, Director
Division of Water Quality
Applicant /Owner's Name (corporation/individual who is legally responsible for the property and its compliance
SOS Management, Inc., David Simmons
Applicant /Owner Address: 351 Piedmont Airline Road City: Goldsboro State: NC Zip: 27534
Applicant's phone number: (919) 751 -9660 Fax number:
Applicant's email address: simmonsdcsimmons @bellsouth.net Mobile Number: (919) 922 -0590
Consultant/Contact person Name (if applicable): Jeffrey L. Kornegay, PE, PLS / B.R. Kornegay, Inc.
Consultant address (if applicable): 300 E. Walnut St., Goldsboro, NC 27530
Consultant's phone number: (919) 735 -5886 Fax number: (919) 580 -9053
Consultant's email address: 4effrey @kornegaysep.com Mobile Number: (919) 921 -0537
Name of Project: Seymour Memorial Park -East County: Wayne
Please specify the number to stream origin determination(s) requesting for this project: 2 # of stream calls
Nearest Named stream + River Basin (from USGS topographic map):
Stonev Creek + Neuse River
Please provide a brief description of this project (attach site plan if available):
Proposed cemetery.
Please attach a map of site location indicating project boundaries using USGS 1:24,000 topo map and NRCS county soil
survey (depicting the streams in question).
Location of project site - please include reference to the county, nearest named town and highway number/ NCSR, etc.
The property is located at the end of Peidmont Airline Road (SR 1755) on the east side. Approximately 0.6 mile from the
intersection of E. Ash Street and Piedmont Airline Road, Goldsboro, NC, Wayne County.
Has any DWQ staff visited the site? No , if yes, please provide DWQ staff name,
visit:
and date of
Does DWQ representative have permission to go on location to conduct the stream determination without the owner present?
Yes or No n (Please check one). If No please specify
This form may be submitted via email to lyn.hardisonnncdenr.gov (252- 948 -3842) or roberto.seheller(a)ncdenr.gov (252 -948-
3940) mailed or hand - delivered to: 943 Washington Square Mall, Washington, NC 27889. (Note: Submittals of the review
packages on Friday after 12: 00 pm tivill be stamped as received on the next business day).
Please contact Chris Pullinger at 252- 948 -3920, if you have any questions regarding this form.
North Carolina Division of Water Quality Internet: h2o.enr.state.nc.us
943 Washington Square Mali Phone: [phone] One
Washington, NC 27889 FAX [phone] No>ithCarolina
An Equal Opportunity /Affirmative Action Employer - 50% Recycled /10% Post Consumer Paper Naturally

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B. R. KORNEGAY, INC.
LAND SURVEYING • ENGINEERING • PLANNING
300 E. Walnut Street
Goldsboro, North Carolina 27530
www.kornegaysep.com (919) 730 -5886 Fax: [phone]
Firm No. F -1054
December 5, 2012
Lyn Hardison
NCDENR
Northeastern Region
943 Washington Square Mall
Washington, N.C. 27889 -3314
Project: SOS Management, Inc., David Simmons
Piedmont Airline Road
Goldsboro, NC
Wayne County
Lyn:
Enclosed is check #1017 from SOS Management, Inc. in the amount of $200 for express stream
call. This is the site I emailed you maps on December 5, 2012.
Sincerely,
*1�7�
Jeffrey L. Kornegay, PE, PLS
jeffrey @kornegaysep.com

Personal Account Information Redacted