20130004 Ver 1_Complete File_20130102

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NCDENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
Natural Resources
Dee Freeman
Secretary
Stream Origin /Buffer Applicability Determination
Applicant /Owner's NamA(corporation/individual who is legally responsible for the property and its compliance:
Applicant /OwneroAddress: f 04S
Applicant's phone number: CA, c� ` f J Z145--.Yp 7
Applicant's email address:
Consultant /Contact person Name (if applicable):
Consultant address (if applicable):
Consultant's phone number:
Consultant's email address:
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Fax number: a✓Fa /3`0�("%p
RECEIVED
Fax number:
Ljvvu—WARO
Name of Project: ?—Qld County: Adwwo7oer
Nearest Named stream + River Basin (from USGS topographic map):
Please provide a brief description of this project (attach site plan if available):
Please attach a map of site location indicating project boundaries using USGS 1:24,000 topo map and NRCS county soil survey.
Location of project site - please include reference to the county, nearest named town and highway number:
Has any DWQ staff visited the site? , if yes, please provide DWQ staff name,
visit:
and date of
This form may be submitted via email (amy.adams a,ncmail.net), faxed (252- 946 - 9215), mailed or hand - delivered to:
943 Washington Square Mall, Washington, NC 27889. (Note: Submittals of the review packages on Friday after 12:00 pm will
be stamped as received on the next business day).
Please contact Amy Adams at 252- 948 -3917 if you have any questions regarding this form.
North Carolina Division of Water Quality Internet: www.newaterqualit
943 Washington Square Mall Phone: [phone] One
Washington, NC 27889 FAX [phone] NorthCarofiina
An Equal Opportunity /Affirmative Action Employer— 50% Recycled /10% Post Consumer Paper Adurallb,

NC DWQ Stream Identification Form Version 4.11
Date:
Project/Site: €� ��
Latitude:
Evaluator:
County:
Longitude:
Total Points:Q_
Stream is at least intermittent �V``� � t >� ,
Stream Determination (circle one)
Ephemeral Intermittent
Other
if z 19 or perennial if Z 30' .�
Perennial
e.g. Quad Name:
\,j
A. Geomorphology (Subtotal = )
Absent
Weak
Moderate
Strong
1a. 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 sequence
0
1
Z
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
B. Headcuts
0
1
2
3
9. Grade control
0
0.5
1
1.5
10. Natural valley
0
015
1
1.5
11. Second or greater order channel
No = 0
Yes = 3
artificial ditches are not rated; see discussions in manual
B. Hvdrologv (Subtotal =
12. Presence of Baseflow
0
1
2
3
13. Iron oxidizing bacteria
0
1
2
3
14. Leaf litter
1
0.5
0
15. Sediment on plants or debris
0
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
C. Biology (Subtotal =
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
1.5
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:v`
,\

1A4
2 5
0 o
7
BM 33
t/ BM A�
&32
1 7
-
-e Bridge
- A-r
, le 1609
t4 P1
4!
all
10, w
Name: PINETOWN
Date: 1/2/2013
Scale: 1 inch equals 1000 feet
jr32
0
,***I
7. 01
Location: 035' 35'21.73" N 076* 50'02.91" W
Caption: Boyd Logging Site off Hwy 32, Acre Station