20121134 Ver 1_Determination Request_20121214

AYI_IXJ
GA",
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
Stream Origin /Buffer Applicability Determination
Applicant /Owner's Name (corporation /individual who is legally responsible for the property and its compliance:
Applicant /Owner Address" .0 . �X ��{Q �co 14 -I 1 jam, 9j���
Applicant's phone number: "3-441 - qC4 I Fax number:
Applicant's email address: IM3L?" 1. CLO L'j KE-0 UVED
Consultant /Contact person Name (if applicable): -aix-5
DEC 1 42012
Consultant address (if applicable): 0 o MoLli O-Z—
Consultant's phone number: ASA- %10 Fax number/ ..A qRO
Consultant's email address:
Name of Project: L. %VGA- I, IAtJ 1 JgL(tQl� �r r County: ?AWVl6
Location of project site - please include reference to the county, nearest named town and highway number:
MA �►� 5- �•,�,,� Cta (fit- t3a►�-+�� �J ov �Q�t��i1c�.,.� TZo ;�no�c i5v - �oNOQs
A�Xz LC F 1 yw� 81 nn Saormaw Fort nU Le* -c dgeiNAA60- AI- tAQP;M t,&F'r of
Please attach a ma of site location indicating project boundaries using USGS 1:24 000 to o ma and NRCS count soil survey.
P g P 1 S P P Y Y•
Has any DWQ staff visited the site ? IJ0 , if yes, please provide DWQ staff name,
date of visit:
and
This form may be submitted via email (amv.adams(@ncdenr.gov), 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.ncwateroualitr'.org
943 Washington Square Mall Phone: [phone] One
Washington, NC 27889 FAX [phone] NorthCarolina
An Equal Opportunity /Affirmative Action Employer - 50% Recycledil0% Post Consumer Paper vVaturilly

NC DWO Stream Identification Form Version 4.11
Date: ..3o
Project/Site: it 3y H
Latitude: a y� 2
Evaluator: •
County:
q Dr�t,CcO
Lorgi£ude: �-
Total Points:
Stream Determination (circle one)
Other
Stream is at least intermittent N nn
�JY
Ephemeral Intermittent Perennial
e.g. Quad Name:
if >_ 19 or perennial if ? 30`
2
3
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,
rip le-pool sequence
0
1 i
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
0.5
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
No = 0
Yes = 3
a artificial ditches are not rated; see discussions in manual
B. Hvdroloav (Subtotal
12. Presence of Baseflow
0
1
2
3
13. Iron oxidizing bacteria
0
1
2
3
14. Leaf litter
1.5
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. Biolo (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 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:
M /1i�._,,n/�7.�r ✓1 DLO �Q"
c.N � �P f

NC DWQ Stream Identification Form Version 4.11
Date: ( , o �1
Project/Site: ' Z_
Latitude:
Evaluator: Avll�- Sc Atx v6 or
County: aMtzz0
Longitude:
Total Points:
Stream Determination (circle one)
Other
Stream is at least intermittent
if >_ 19 or perennial if _> 30* 1 1 -'
Ephemeral Intermittent Perennial
e.g. Quad Name: (� .
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
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
0.5
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
No = 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
0
1
2
3
14. Leaf litter
1.5
1
0.5
0
15. Sediment on plants or debris
0
0.5
1
1.5
16. Organic debris lines or piles
0
1 0.5
1
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
&
0.5
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:
tAPV- 4
tL`Iliti%� /n
i P46 -'>
r