20211303 Ver 1_ePCN Application_20210829

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
r Yes r No
Change only if needed.
BIMS # Assigned
20211303
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
Information for Initial Review
1a. Name of project:
Patterson Avenue Emergency Repair Project
1a. Who is the Primary Contact?*
Todd Love, PE
1b. Primary Contact Email:*
[e-mail]
Date Submitted
8/29/2021
Nearest Body of Water
North School Branch
Basin
Yadkin -Pee Dee
Water Classification
Class C
Site Coordinates
Version#*
1
What amout is owed?*
IT $240.00
r $570.00
Select Project Reviewer*
Sue Homewood:eads\slhomewood
1c. Primary Contact Phone:*
[phone]
Latitude:
Longitude:
36.110258
-80.241882
Processing Information
u
County (or Counties) where the project is located:
Forsyth
Is this a NCDMS Project
r Yes IT No
Is this project a public transportation project?*
r Yes r No
Pre -Filing Meeting Information
Is this a courtesy copy notification?*

r Yes r No
ID#
Version
Pre -fling Meeting or Request Date
7/16/2021
Attach documentation of Pre -Filing Meeting Request here:
Qick the upload button or drag and drop files here to attach document
DWR Pre -Filing Meeting Request Form.pdf
File type must be FCF
1a. Type(s) of approval sought from the Corps:
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
r Yes
r No
1b. What type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number: 03 - Maintenance
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual 401 Water Quality Certification
le. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR 401 Certification:
For the record onlyfor Corps Permit:
54.14KB
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
r Owner W Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
City of Winston Salem
2b. Deed book and page no.:
r Yes r No
r Yes r No
2c.Contact Person:

Mr. Todd Love, PE
2d.Address
Street Address
101 North Main Street
Address tine 2
CKY
Winston Salem
Postal / Zip Code
27101
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Todd Love, PE
3b. Business Name:
City of Winston Salem
3c.Address
Street Address
101 North Main Street
Address Line 2
city
Winston Salem
Postal / Zip Code
27101
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Benjamin Burdette
4b. Business Name:
HDR Engineering, Inc.
4c.Address
Street Address
440 South Church Street
Address Line 2
Suite 900
city
Charlotte
Postal / Zip Code
28202-1919
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
City of Winston Salem
F-
2. Project Identification
State / province / legion
NC
Country
USA
2f. Fax Number:
Slate / province / Region
NC
Country
USA
3e. Fax Number:
Slate / province / legion
NC
Country
USA
4e. Fax Number:

2a. Property Identification Number:
6836310349, 6836313319, 6383631227,
6836218096
2c. Project Address
Street Address
East and west of N Patterson Avenue, South of E Northwest Boulevard
Address tine 2
City
Winston Salem
Postal / Zip Code
27101
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
North School Branch
3b. Water Resources Classification of nearest receiving water:*
Class C
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401011305
4. Project Description and History
2b. Property size:
0.4
State / Amine / Fbgion
NC
Country
USA
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
The Project Area for the proposed culvert replacement is located in a well -developed urban area with the only permeable surfaces areas remaining located within the floodplain of North
School Branch. Currently the culvert and roadway slope are failing and need to be replaced.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
0.0
4g. List the total estimated linear feet of all existing streams on the property:
269
4h. Explain the purpose of the proposed project:*
The Patterson Avenue Emergency Repair project is in response to culvert and roadway slope failures occurring at the North Patterson Avenue crossing over a named stream, North
School Branch (Study Area). The City of Winston-Salem (City) desires to replace the existing culvert to stabilize the eroding stream banks and immediate surrounding area
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The City proposes to remove an existing 72" CMP culvert that is located in line with North School Branch and replace it with a 111' long, 84" reinforced concrete pipe (RCP) at a 3
slope. The culvert replacement will result in the permanent impacts 14' of streambed upstream of the culvert and 8' downstream of the due to the newculvert length. This is in addition
to 36' of streambed loss due to the addition of riprap to protect the inflow and outflow of the culvert. Total permanent stream impacts are 58 linear feet.
Work will require cofferdams to be placed upstream so that the work can be completed in the dry, with pump arounds being implemented to maintain flow. This will result in 40' of
temporary fill associated with impervious dikes and de -watering impacts . The new culvert will be installed approximately 1 foot belowthe existing streambed at a slope that allows for
passage of water and movement of aquatic life. Standard construction equipment will be used, such as excavators, backhoes, hauling trucks, etc.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
A PJD verification was submitted to the USACE Raleigh district on 8/27/2021
5b. If the Corps made a jurisdictional determination, what type of determination was made?
r Preliminary r Approved G Not Verified r Unknown r N/A
Corps AID Number:
SAW-2021-01868
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Benjamin Burdette, WPIT
Agency/Consultant Company: HDR Engineering, Inc.
Other:
r Unknown
6. Future Project Plans

6a. Is this a phased project?*
r Yes r No
Are anyother NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed projector related activity?
ND
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries F Buffers
r Open Waters r Pond Construction
3. Stream Impacts
3a. Reason for impact (?)
3b.lmpact type *
3c. Type of impact*
3d. S. name*
3e. Stream Type *
3f. Type of
3g. S. width*
3h. Impact
❑
(?) 11
Jurisdiction"
length"
S1
Extending culvert past
9
Permanent
Culvert
North School Branch
Perennial
Both
15
14
exsting slope (upstream)
Average (feet)
(li �rfeet)
S2
Extending culvert pa
9 P
Permanent
Culvert
��chool Branch
Perennial
Both
15
8
exsting slope (downstream)
Average (feet)
(lin�rfeet)
S3
Adding rip rap protection
Permanent
Rip Rap Fill
North School Branch
Perennial
Both
15
18
(upstream)
Average (feet)
(linearfeet)
Sq
Adding rip rap protection
Permanent
Rip Rap Fill
North School Branch
Perennial
Both
15
18
(downstream)
Average (feet)
(lirx�rfeet)
S5
Pump around and cofferdam
Temporary
Dewatering
North School Branch
Perennial
Both
15
20
(upstream)
Average (feet)
(linearfeet)
S6
Pump around and cofferdam
Temporary
Dewatering
North School Branch
Perennial
Both
(upstream)
�_]
]�;J;;]
31. Total jurisdictional ditch impact in square feet:
3i. Total permanent stream impacts:
58
31. Total stream and ditch impacts:
98
3i. Total temporary stream impacts:
40
3j. Comments:
Cofferdam and devmtering are to be minimized in their footprint with a pump around providing continued flow.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Onsite surface waters were delineated with the intention of minimizing impact during the culvert design. Impacts to jurisdictional waters are minimized to
the point of allowing safe and stable banks and culvert footings. The culverts will be installed approAmately 1 foot belowthe existing stream bed at a
slope that allows for passage of water and movement of aquatic life. Stream bed material (i.e., cobbles/gravels) will be placed in the culvert to mimic
natural instream conditions. Erosion and sediment control measures will be implemented before and continue throughout the duration of the project.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The project will be constructed in the dry and surrounding construction area will be stabilized via sediment and erosion control devices. Disturbed
stream banks will be sloped back, seeded with native vegetation, and matted with biodegradable erosion control material. A pump -around will be
installed to work in the dry. The water Will be pumped through a sediment filter bag before returning to the stream.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Impacts do not exceed 1/10-acre of wetlands. In addition, stream impacts were minimized to avoid unnecessary impacts. Total stream impacts are below 150 LF.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
U
1. Diffuse Flow Plan

1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
The proposed Project Area is not located in a watershed that is subject to the NC Riparian Buffer Protection Rules.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r- Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15ANCAC 02H .1003(2)?
r Yes r- No
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the requirements of the National or State (North Carolina)
Environmental Policy Act (NEPA/SEPA)? *
r- Yes r No
Comments:*
No, this is the emergency repair of an epsting culvert and does not require NEPA/SEPA environmental documentation.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 21-1.1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?*
r- Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r- Yes r No
3b. If you answered "no," provide a short narrative description.
Project will not result in additional development as the proposed work is to provide maintenance for the continued use of an eAsting road.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r- Yes r Nor NIA
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r- Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r- Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r- Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No

5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
HDR Engineering, Inc. queried the USFWS information for Planning and Conservation (IPaC) online mapping system for information on threatened
and endangered species, and the designated or proposed critical habitat that may be affected by the project. Additionally, the USFWS Endangered
Species Database was reviewed to identify federally protected species in Forsyth County, North Carolina.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes
r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
hftps://wmAf.habitat.noaa.gov/protection/efh/efhmapper/
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
r Yes
r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
HDR Engineering, Inc. reviewed the NCSHPO GIS website to obtain information regarding historic resources present on the site or in the nearby
properties. This review did not identify any listed properties or sites eligible for listing.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
Coordination is being carried out Wth the local floodplain administrator to ensure compliance within the FEMA guidelines.
8c. What source(s) did you use to make the floodplain determination?*
FEMA map numbers 3710683500J.
Miscellaneous
U
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one
file when possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
dick the upload button or drag and drop files here to attach docurrent
3_Fig_1_USGS.pdf
2.25MB
4_Fig-2_Soils.pdf
932.85KB
6_2021.07.19_Patterson_PJD.pdf
11.33MB
Pages from 20210820 Patterson (002).pdf
2.14MB
Re crust be FLF or INK
Comments
Signature v
17 By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Benjamin Griffin Burdette
Signature
Date
8/29/2021

TOP
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LEGEND
Study Area
(0.4 acres)
Forsyth Soils
DATA SOURCE: NRCS Soil Survey of Forsyth
County, INC, Bing Hybrid Aerial Imagery
A
0 Feet 100
1 inch = 100 feet
r-]
L
FfC
19-
1
PATTERSON AVENUE EMERGENCY REPAIR PROJECT
FnNRCS SOIL SURVEY OF FORSYTH COUNTY, NC
FIGURE 2

July 14, 2021
To Samantha Dailey
U.S. Army Corps of Engineers, Wilmington District
69 Darlington Avenue
Wilmington, North Carolina 28403
Subject: Patterson Avenue Emergency Repair Project
Preliminary Jurisdictional Determination Request
Forsyth County, North Carolina
To Samantha Dailey,
The Patterson Avenue Emergency Repair project is in response to culvert and roadway slope failures
occurring at the North Patterson Avenue crossing over a named stream, North School Branch (Study Area).
The City of Winston-Salem (City) desires to replace the existing culvert and stabilize the surrounding area
(Appendix A, Figures 1 and 2). HDR Engineering, Inc. of the Carolinas (HDR) has been authorized by the
City as its agent to submit the enclosed Preliminary Jurisdictional Determination (PJD) Request for written
verification from the U.S. Army Corps of Engineers (USACE) regarding the extent of Potential Waters of
the U.S. (WOUS) within the Study Area (Appendix B).
Applicant Name: The City of Winston-Salem; POC: Tod Love
Mailing Address: 101 North Main Street, Winston Salem, NC 27101
Phone Number of Owner/Applicant: [phone]
Project Site Location: North Patterson Avenue crossing over North School Branch; Winston Salem, NC
Basin: Yadkin Pee Dee (Hydrologic Unit Code [HUC] 030401011305)
Nearest City/Township: City of Winston-Salem
County: Forsyth County
Center Decimal Degree Coordinates of Project Site: 36.110258°,-80.241882'
U.S. Geological Survey Quadrangle Name: Winston-Salem East, NC (1994) (1":24,000'-scale)
Project Site Description
Prior to undertaking fieldwork, HDR scientists conducted a desktop review of the Study Area utilizing a
number of resources including U.S. Geological Survey (USGS) topographic maps (Appendix A, Figure 2),
aerial imagery (Appendix A, Figure 3), United States Department of Agriculture (USDA) Natural Resources
Conservation Service (NRCS) Soil Survey (Appendix A, Figure 4), the USGS National Hydrography Dataset
(NHD), U.S. Fish and Wildlife Service (USFWS) National Wetland Inventory (NWI), and Federal Emergency
Management Act (FEMA) floodplains (Appendix A, Figure 5), and HUC watershed boundaries (Appendix
A, Figure 6).
According to the NRCS Soil Survey of Forsyth County, only one soil type is within the Study Area, Fairview- ■
urban land complex, 10 to 25 percent slopes (FfE) and it is not hydric according to the National Hydric Soils
List (Appendix A, Figure 4).
The USFWS NWI provides wetlands data and analysis available to the public. A review of the USFWS NWI
depicts one (1) riparian wetland within the Study Area associated with North School Branch (Appendix A,
Figure 5). The USGS NHD provides digital geospatial datasets to the public that map a network of surface
waters and catchments of the U.S. A review of the USGS NHD depicts one (1) stream within the Study
hdrinc.com
440 South Church Street, Suite 1000, Charlotte, NC 28202-2075
T 704.338.6700 F 704.338.6761

Patterson Avenue Emergency Repair Project I Forsyth County, North Carolina
Preliminary Jurisdictional Determination Request
Area (Appendix A, Figure 5). A 100-year FEMA floodplain is present within the Study Area (FEMA FIRM
Panel 3710683500J eff. 1/2/2009) (Appendix A, Figure 5).
Jurisdictional Delineation
On March 30, 2021 HDR environmental scientists Ben Burdette, Wetland Professional in Training (WPIT)
and Charles Gruenberg reviewed the Study Area for Potential WOUS under Section 404 of the Clean Water
Act. Potential WOUS were delineated according to the methodology and guidance described in the USACE
1987 Wetland Delineation Manual, the 2020 Navigable Waters Protection Rule (NWPR), and the 2012
USACE Eastern Mountains Piedmont Regional Supplement (Version 2.0). Streams were classified utilizing
the methodology and guidance provided by North Carolina Department of Water Quality (NCDWQ) and the
NCDWQ Stream Identification Form (Version 4.11). Potentially (WOUS) were flagged in the field and
mapped using a Trimble° GeoXT GPS unit capable of sub -meter accuracy. GPS points were post -
processed utilizing Trimble°GPS Pathfinder Office software. Attached to this submittal are a completed
USACE Wetland Determination Data Form and Stream Identification Form (Appendix C) and representative
photographs of on -site waters (Appendix D).
Results
The results of the on -site field investigation conducted by HDR indicate that there is one (1) Potential WOUS
(North School Branch) within the Study Area (Appendix A, Figure 7). On -site waters drain to the west
towards Peter Creek which is classified by North Carolina Department of Environmental Quality (NCDEQ)
as a C Water.
Jurisdictional Streams
On -site Potential WOUS include a stream that totals approximately 269 linear feet (0.08 acres) (Appendix
A, Figure 7). A summary of on -site Potential WOUS is provided in Table 1.
Table 1. Summary of On -Site Potential Waters of the U.S.
36.110275/ 36.110237/ Length: 269 feet
Stream 1-80.241379-80.242646 R3RB2 Width: 3-25 feet
Area: 0.08 acres
Total Potential WOUS: Length: 269 linear feet
Area: 0.08 acres
R5UB1 = Riverine, perennial, cobble -gravel streambed

Patterson Avenue Emergency Repair Project I Forsyth County, North Carolina
Preliminary Jurisdictional Determination Request
On behalf of the City of Winston-Salem, HDR is hereby requesting an PJD verification request for the
Potential WOUS identified within the Study Area. Should you have any questions or require additional
information following your review of the enclosed materials, please contact me at [phone] or
beniamin.burdetteandrinc.com.
Sincerely,
HDR, Inc.
Ben Burdette, WPIT
Environmental Scientist
Kelly ThAmes, PWS, TN-QHP
Environmental Project Manager
Appendices: Appendix A: Figures
Figure 1. Vicinity Map
Figure 2. USGS Topographic Quadrangles
Figure 3. Aerial Map and Acreage
Figure 4. NRCS Soils Survey of Forsyth County, North Carolina
Figure 5. NHD, NWI, and FEMA Flood Zones
Figure 6. 12-Digit HUC Watershed
Figure 7. Potential Waters of the U.S.
Appendix B: USACE Jurisdictional Determination
Jurisdictional Determination Request and PJD Form
Appendix C: Data Forms
NCDWQ Field Data Sheets
USACE Wetland Determination Data Forms
USACE Antecedent Precipitation Tool
Appendix D: Site Photographs

Appendix A
Figures

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(0.4 acres)
DATA SOURCE: Esri World
Topographic Map Service
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1 inch = 0.5 mile
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PATTERSON AVENUE EMERGENCY
REPAIR PROJECT
FN
VICINITY MAP
FIGURE 1

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LEGEND
7 Study Area (0.4
acres)
7-1 Forsyth County
Parcel Boundaries
DATA SOURCE: Bing Hybrid Aerial Imagery
0 Feet 100
1 inch = 100 feet
1
.�+M+ pf
6836218098 3
w
AI
PATTERSON AVENUE EMERGENCY REPAIR PROJECT
AERIAL MAP AND ACREAGE
FIGURE 3

LEGEND
-1 Study Area
(0.4 acres) '
Forsyth Soils '
�w
DATA SOURCE: NRCS Soil Survey of Forsyth
County, NC, Bing Hybrid Aerial Imagery
0 Feet 100
1 inch = 100 feet
r-]
L
a r r
IMI IN
IFVI2W-U
FfC r
PATTERSON AVENUE EMERGENCY REPAIR PROJECT
FnNRCS SOIL SURVEY OF FORSYTH COUNTY, NC
FIGURE 4

LEGEND
Study Area ,
(0.4 acre) }
NHD Stream
®NWI
Wetlands
100-Year
Flood Zone
DATA SOURCE: USGS National Hydrography
Dataset(NHD);
USFWS National Wetlands Inventory (NW),
FEMA National Flood Hazard Layer
(NFHL), Bing Hybrid Aerial Imagery
0 Feet 100
1 inch = 100 feet
t
PATTERSON AVENUE EMERGENCY REPAIR PROJECT
NHD, NWI AND FEMA FLOOD ZONES
FIGURE 5

`1
LEGEND o.
Study Area ��y 94R ti CDak s
(0.4 acres)
HUC 12 U �a
Watershed
Boundaries
DATA SOURCE: USGS National tiC
Hydrography Dataset, HUC 12 IA
Watersheds (NHD)
© 1S%
0 Miles 1 `eek
1 inch = 1/mile
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PATTERSON AVENUE EMERGENCY REPAIR PROJECT
FN12-DIGIT HYDROLOGIC UNIT CODE (HUC) WATERSHED
FIGURE 6

LEGEND
0 Study Area
(0.4 acres)
Potential
- WOUS
Stream
Culvert
Upland Data
Point
Photos
DATA SOURCE: Bing Hybrid Aerial Imagery
0 Feet 100
1 inch = 100 feet
Potential Water of the U.S.
(Perennial Stream 1, 269 If)
PATTERSON AVENUE EMERGENCY REPAIR PROJECT
POTENTIAL WATERS OF THE U.S.
FIGURE 7

Appendix B
USACE Jurisdictional
Determination
Jurisdictional Determination
Request and PJD Form

AGENT CERTIFICATION OF AUTHORIZATION
I, Todd Love, representing The City of Winston Salem hereby certify that I have
authorized Ben Burdette of HDR to act on my behalf and take all actions necessary to the
processing, issuance, and acceptance of this request for wetlands determination /
permitting and any and all standard and special conditions attached.
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
Applicant's signature
Date
Agent's signature
Date
7/19/2021
Completion of this form will allow the agent to sign all future application correspondence.

urisdictional Determination Reauest
US Army Corps
of Engineers.
Wilmington District
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www.saw.usace.aimy.mil/Missions/Re ul�atoiyPermitProi4ram/Contact/CountyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
INSTRUCTIONS:
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
may not be valid for the wetland conservation provisions of the Food Security Act of
1985. If you or your tenant are USDA Program participants, or anticipate participation in
USDA programs, you should also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: North Patterson Avenue
City, State:
Winston-Salem, NC
County: Forsyth
Parcel Index Number(s) (PIN): 6836-21-8098.000
B. REQUESTOR INFORMATION
Name: Beniamin Burdette
Mailing Address: 440 S. Church Street, Suite 1000
Charlotte, NC
Telephone Number: [phone]
Electronic Mail Address: [e-mail]
Select one:
❑ I am the current property owner.
❑ I am an Authorized Agent or Environmental Consultanti
❑ Interested Buyer or Under Contract to Purchase
❑ Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: City of Winston Salem
Mailing Address: 1200 N Patterson Ave
Telephone Number:
Electronic Mail Address:
Winston Salem, NC 27101
[phone]
[e-mail]
1 Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION',4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Benjamin Burdette
Print Name
Capacity: ❑ Owner Z Authorized Agents
07/19/2021
Date
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a projector perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a projector perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
0 I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
❑ I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
❑ I intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
❑ A Corps JD is required in order obtain my local/state authorization.
❑ I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑ Other:
s For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
a If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
s Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERNIINATION (JD) TYPE (Select One)
0 I am requesting that the Corps provide a preliminM JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
❑ I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
❑ I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
✓� Size of Property or Review Area 0.40 acres.
❑✓ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
Project Coordinates (Decimal Degrees): Latitude:
36.110258
Longitude:-80.241882
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than I Ix 17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. hM2://www.saw.usace.4rmy.mil/Missions/Regulatoly-Permit-
Pro gram/Jurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
F4Completed appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDS• please complete an Approved Jurisdictional Determination Form'.
Vicinity Map
Aerial Photograph
F4 USGS Topographic Map
0 Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
❑✓ NC Division of Water Resources Stream Identification Forms
l rJ Other Assessment Forms
' www.saw.usace.4rmy.mil/Portals/59/docs/regulatory/readocs/JD/RGL 08-02_App A Prelim _JD_Form fillable.pdf
8 Please see hM2://www.saw.usace.4M.mil/Missions/Regulatory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federaljurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD:
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Benjamin Burdette, 440 S. Church Street, Charlotte, NC 28202
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington District
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Forsyth City: Winston-Salem
Center coordinates of site (lat/long in degree decimal format):
Lat.: 36.110258 Long.:-80.241882
Universal Transverse Mercator: NAD83
Name of nearest waterbody: North School Branch
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date: 07/19/2021
❑■ Field Determination. Date(s): March 30, 2021
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (i.e., wetland
vs. non -wetland
waters)
Geographic authority
to which the aquatic
resource "may be"
subject (i.e., Section
404 or Section 10/404)
Stream 1
36.110275
-80.241379
269 If; 0.08 acres
non -wetland waters
Section 404

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requestor of this PJD is hereby advised of his or her option
to request and obtain an approved JD (AJD) for that review area based on an
informed decision after having discussed the various types of JDs and their
characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a
Nationwide General Permit (NWP) or other general permit verification requiring "pre -
construction notification" (PCN), or requests verification for a non -reporting NWP or
other general permit, and the permit applicant has not requested an AJD for the
activity, the permit applicant is hereby made aware that: (1) the permit applicant has
elected to seek a permit authorization based on a PJD, which does not make an
official determination of jurisdictional aquatic resources; (2) the applicant has the
option to request an AJD before accepting the terms and conditions of the permit
authorization, and that basing a permit authorization on an AJD could possibly result
in less compensatory mitigation being required or different special conditions; (3) the
applicant has the right to request an individual permit rather than accepting the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can
accept a permit authorization and thereby agree to comply with all the terms and
conditions of that permit, including whatever mitigation requirements the Corps has
determined to be necessary; (5) undertaking any activity in reliance upon the subject
permit authorization without requesting an AJD constitutes the applicant's acceptance
of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps permit
authorization based on a PJD constitutes agreement that all aquatic resources in the
review area affected in any way by that activity will be treated as jurisdictional, and
waives any challenge to such jurisdiction in any administrative or judicial compliance
or enforcement action, or in any administrative appeal or in any Federal court; and (7)
whether the applicant elects to use either an AJD or a PJD, the JD will be processed
as soon as practicable. Further, an AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively
appealed pursuant to 33 C.F.R. Part 331. If, during an administrative appeal, it
becomes appropriate to make an official determination whether geographic
jurisdiction exists over aquatic resources in the review area, or to provide an official
delineation of jurisdictional aquatic resources in the review area, the Corps will
provide an AJD to accomplish that result, as soon as is practicable. This PJD finds
that there "may be" waters of the U.S. and/or that there "may be" navigable waters of
the U.S. on the subject review area, and identifies all aquatic features in the review
area that could be affected by the proposed activity, based on the following
information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
■❑ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map:See Appendix A for full set of maps.
0 Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
■❑ U.S. Geological Survey Hydrologic Atlas:
■❑
■❑
■❑ U.S
USGS NHD data.
USGS 8 and 12 digit HUC maps.
Geological Survey map(s). Cite scale & quad name: Winston-Salem East 24k
■❑ Natural Resources Conservation Service Soil Survey. Citation
Forsyth County
■❑ National wetlands inventory map(s). Cite name: HUC 030401011305
❑ State/local wetland inventory map(s):
■FEMA/FIRM maps: 3710683500J
❑ 100-year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
■❑ Photographs: ■❑ Aerial (Name & Date): Bing Aerial Photographs
or ■❑ Other (Name & Date): Field Photographs 3/30/2021
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
Signa and date of
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
' Districts may establish timeframes for requestor to return signed PJD forms. If the requestor does not respond
within the established time frame, the district may presume concurrence and no additional follow up is
necessary prior to finalizing an action.

Appendix C
Data Forms

U.S. Army Corps of Engineers OMB Control#: 0710-xxxx, Exp: Pending
WETLAND DETERMINATION DATA SHEET — Eastern Mountains and Piedmont Region Requirement Control Symbol EXEMPT:
See ERDC/EL TR-07-24; the proponent agency is CECW-CO-R (Authority: AR 335-15, paragraph 5-2a)
Project/Site: Patterson Drive Culvert Replacement City/County: Forsyth Co, NC Sampling Date: 03/30/2021
Applicant/Owner: City of Winston-Salem State: NC Sampling Point: DP1-Up
Investigator(s): Ben Burdette, WPIT Section, Township, Range:
Landform (hillside, terrace, etc.): Hillside Local relief (concave, convex, none): Convex
Subregion (LRR or MLRA): LRR P, MLRA 136 Lat: 36.110294 Long:-80.242207
Slope (%): 30
Datum: NAD83
Soil Map Unit Name: Fairview -Urban land complex, 10 - 25 percent slopes FfE NWI classification: Upland
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 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 X Is the Sampled Area
Hydric Soil Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks:
Data point is representative of study area adjacent to stream. A highly urban environment with large amounts of rubble, brick, concrete,
terracotta pipes etc. strewn throughout. According to the USACE Antecedent Precipitation Tool, conditions at the time were wetter than normal
HYDROLOGY
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 (1314)
_Sparsely Vegetated Concave Surface (138)
_ High Water Table (A2) —Hydrogen
Sulfide Odor (Cl)
—Drainage Patterns (1310)
—Saturation (A3) —Oxidized
Rhizospheres on Living Roots (C3)
—Moss Trim Lines (1316)
—Water Marks (131) —Presence
of Reduced Iron (C4)
_ Dry -Season Water Table (C2)
_Sediment Deposits (132) _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 (135)
_Geomorphic Position (D2)
—Inundation Visible on Aerial Imagery (137)
—Shallow Aquitard (D3)
—Water-Stained Leaves (139)
Microtopographic Relief (D4)
Aquatic Fauna (1313)
FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No
X Depth (inches):
Water Table Present? Yes No
X Depth (inches):
Saturation Present? Yes No
X Depth (inches):
Wetland
Hydrology Present? Yes No X
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
Wetland hydrology is absent.
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point: DP1-Up
Absolute Dominant
Indicator
Tree Stratum (Plot size: 30 )
% Cover Species?
Status
Dominance Test worksheet:
1
Number of Dominant Species
2.
That Are OBL, FACW, or FAC: 0 (A)
3.
Total Number of Dominant
4.
Species Across All Strata: 2 (B)
5.
Percent of Dominant Species
6.
That Are OBL, FACW, or FAC: 0.0% (A/B)
7.
Prevalence Index worksheet:
=Total Cover
Total % Cover of: Multiply by:
50% of total cover:
20% of total cover:
OBL species 0 x 1 = 0
Sapling/Shrub Stratum (Plot size: 15
)
FACW species 0 x 2 = 0
1. Phytolacca americana
5 Yes
FACU
FAC species 0 x 3 = 0
2.
FACU species 10 x 4 = 40
3.
UPL species 95 x 5 = 475
4.
Column Totals: 105 (A) 515 (B)
5.
Prevalence Index = B/A = 4.90
6.
Hydrophytic Vegetation Indicators:
7.
_ 1 - Rapid Test for Hydrophytic Vegetation
8.
2 - Dominance Test is >50%
9.
- Prevalence Index is <-3.0'
5 =Total Cover
-3
4 - Morphological Adaptations' (Provide supporting
50% of total cover:
3 20% of total cover:
1
data in Remarks or on a separate sheet)
Herb Stratum (Plot size: 5 )
-Problematic Hydrophytic Vegetation' (Explain)
1. Pueraria montana
90 Yes
UPL
'Indicators of hydric soil and wetland hydrology must be
2. Valerianella locusta
5 No
UPL
present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
3. Galium aparine 5 No FACU
4.
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
5.
more in diameter at breast height (DBH), regardless of
6
height.
7.
Sapling/Shrub - Woody plants, excluding vines, less
8.
than 3 in. DBH and greater than or equal to 3.28 ft
9
(1 m) tall.
10.
Herb - All herbaceous (non -woody) plants, regardless
11.
of size, and woody plants less than 3.28 ft tall.
100 =Total Cover
Woody Vine - All woody vines greater than 3.28 ft in
50% of total cover:
50 20% of total cover:
20
height.
Woody Vine Stratum (Plot size: )
1.
2.
3.
4.
5.
Hydrophytic
=Total Cover
Vegetation
50% of total cover:
20% of total cover:
Present? Yes No X
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic vegetation is not present.
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: DP1-Up
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) % Type' Locz Texture Remarks
M
7.5YR 5/4 100 Loamy/Clayey Gravely
'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains.
2Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric Soils3:
Histosol (Al)
Polyvalue Below Surface (S8) (MLRA 147, 148)
2 cm Muck (A10) (MLRA 147)
Histic Epipedon (A2)
_Thin Dark Surface (S9) (MLRA 147, 148)
_Coast Prairie Redox (A16)
—Black Histic (A3)
—Loamy Mucky Mineral (F1) (MLRA 136)
(MLRA 147, 148)
—Hydrogen Sulfide (A4)
—Loamy Gleyed Matrix (F2)
—Piedmont Floodplain Soils (F19)
_Stratified Layers (A5)
_Depleted Matrix (F3)
(MLRA 136, 147)
_2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
—Red Parent Material (F21)
—Depleted Below Dark Surface (A11)
—Depleted Dark Surface (F7)
(outside MLRA 127, 1479 148)
_Thick Dark Surface (Al2)
_Redox Depressions (F8)
_Very Shallow Dark Surface (F22)
_Sandy Mucky Mineral (S1)
_Iron -Manganese Masses (F12) (LRR N,
_Other (Explain in Remarks)
_Sandy Gleyed Matrix (S4)
MLRA 136)
—Sandy Redox (S5)
_ Umbric Surface (F13) (MLRA 122, 136)
3Indicators of hydrophytic vegetation and
_Stripped Matrix (S6)
_Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present,
Dark Surface (S7)
Red Parent Material (F21) (MLRA 127, 1479 148)
unless disturbed or problematic.
Restrictive Layer (if observed):
Type: Concrete, brick and debris
Depth (inches): 6 Hydric Soil Present? Yes No X
Remarks:
Hydric soil absent. At 6" a layer of debris was hit that prevented further soil pulls. Several locations in the area were tried with similar results.
ENG FORM 6116-4-SG, JUL 2018 Eastern Mountains and Piedmont — Version 2.0

NC DWQ Stream Identification Form Version 4.11
Date: 03/30/2021
Project/Site: Patterson Drive Culvert
Latitude: 36.110269
Evaluator: Ben Burdette, WPIT
county: Forsyth County, NC
Longitude: _80.242315
Total Points:
Stream Determination c
(
Other Winston-Salem
Stream is at least intermittent
32nermen
erennia
Ephemeral Itittt l
e.g. Quad East
d NEt 124k
if>_ 19 or perennial if>_ 30`
A. Geomorphology (Subtotal = 16.5 )
Absent
Weak
Moderate
Strong
1a. Continuity of channel bed and bank
0
1
2
0
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
CD
4. Particle size of stream substrate
0
1
0
3
5. Active/relict floodplain
0
©
2
3
6. Depositional bars or benches
0
1
2
03
7. Recent alluvial deposits
QO
1
2
3
8. Headcuts
0
10
2
3
9. Grade control
0
0.5
1
CD
10. Natural valley
0
0.5
10
1.5
11. Second or greater order channel
U No
= 0-1
Yes = 3
a artificial ditches are not rated; see discussions in manual
B. Hydrology (Subtotal = 9.5 )
12. Presence of Baseflow
0
1
2
13. Iron oxidizing bacteria
1
2
3
14. Leaf litter
1.5
1
0.5
0
15. Sediment on plants or debris
0
.5
1
1.5
16. Organic debris lines or piles
0
1 0.5
1
17. Soil -based evidence of high water table?
No = 0
Yes = 3
C. Biology (Subtotal = 6
18. Fibrous roots in streambed
1 2
1
0
19. Rooted upland plants in streambed
CD
2
1
0
20. Macrobenthos (note diversity and abundance)
QO
1
2
3
21. Aquatic Mollusks
co
1
2
3
22. Fish
CD
0.5
1
1.5
23. Crayfish
CD
0.5
1
1.5
24. Amphibians
00
0.5
1
1.5
25. Algae
CD
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL =
1.5 JM77 0
'perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: BH: 2 - 20' BW. 4 - 15' Bedrock present in areas, gravel, urban refuse and debris throughout. Lack of algae and aquatic life leads to
believe that water was impacted in some way. Multiple small collapsed stormwater culverts entering upstream.
Sketch:

NC SAM FIELD ASSESSMENT RESULTS
M%.A0U111[Jd111CJ UJCI IVlsllludi VCI JIUII L.1
USACE AID #: NCDWR #:
INSTRUCTIONS: Attach a sketch of the assessment area and photographs. Attach a copy of the USGS 7.5-minute topographic quadrangle,
and circle the location of the stream reach under evaluation. If multiple stream reaches will be evaluated on the same property, identify and
number all reaches on the attached map, and include a separate form for each reach. See the NC SAM User Manual for detailed descriptions
and explanations of requested information. Record in the "Notes/Sketch" section if supplementary measurements were performed. See the
NC SAM User Manual for examples of additional measurements that may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT/SITE INFORMATION:
1. Project name (if any): Patterson Culvert Replacement
3. Applicant/owner name: City of Winston Salem
5. County: Forsyth
7. River basin: Yadkin-PeeDee
Date of evaluation: 03/30/2021
Assessor name/organization: Benjamin Burdette/HDR
Nearest named water body
on USGS 7.5-minute quad: Peter Creek
8. Site coordinates (decimal degrees, at lower end of assessment reach): 36.110266,-80.241361
STREAM INFORMATION: (depth and width can be approximations)
9. Site number (show on attached map): Stream 1 10. Length of assessment reach evaluated (feet): 100
11. Channel depth from bed (in riffle, if present) to top of bank (feet): 2 feet ❑Unable to assess channel depth.
12. Channel width at top of bank (feet): 30 feet 13. Is assessment reach a swamp steam? ❑Yes ❑No
14. Feature type: ®Perennial flow ❑Intermittent flow ❑Tidal Marsh Stream
STREAM CATEGORY INFORMATION:
15. NC SAM Zone: ❑ Mountains (M) ® Piedmont (P) ❑ Inner Coastal Plain (1) ❑ Outer Coastal Plain (0)
16. Estimated geomorphic ❑A� ®B
valley shape (skip for
Tidal Marsh Stream): (more sinuous stream, flatter valley slope) (less sinuous stream, steeper valley slope)
17. Watershed size: (skip ❑Size 1 (< 0.1 mi2) ®Size 2 (0.1 to < 0.5 mil) ❑Size 3 (0.5 to < 5 mil) ❑Size 4 (>_ 5 mil)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION:
18. Were regulatory considerations evaluated? ❑Yes ®No If Yes, check all that apply to the assessment area.
❑Section 10 water ❑Classified Trout Waters ❑Water Supply Watershed (❑l ❑II ❑III ❑IV ❑V)
❑Essential Fish Habitat ❑Primary Nursery Area ❑ High Quality Waters/Outstanding Resource Waters
❑Publicly owned property ❑NCDWR Riparian buffer rule in effect ❑Nutrient Sensitive Waters
❑Anadromous fish ❑303(d) List ❑CAMA Area of Environmental Concern (AEC)
❑Documented presence of a federal and/or state listed protected species within the assessment area.
List species:
❑Designated Critical Habitat (list species)
19. Are additional stream information/supplementary measurements included in "Notes/Sketch" section or attached? ®Yes ❑No
1. Channel Water— assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
®A Water throughout assessment reach.
❑B No flow, water in pools only.
❑C No water in assessment reach.
2. Evidence of Flow Restriction — assessment reach metric
❑A At least 10% of assessment reach in -stream habitat or riffle -pool sequence is severely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes or ponded water or impoundment on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates, debris jams,
beaver dams).
®B Not
3. Feature Pattern — assessment reach metric
®A A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
❑B Not
4. Feature Longitudinal Profile — assessment reach metric
❑A Majority of assessment reach has a substantially altered stream profile (examples: channel down -cutting, existing damming, over
widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of these
disturbances).
®B Not
5. Signs of Active Instability — assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
active bank failure, active channel down -cutting (head -cut), active widening, and artificial hardening (such as concrete, gabion, rip -rap).
❑A < 10% of channel unstable
®B 10 to 25% of channel unstable
❑C > 25% of channel unstable

Streamside Area Interaction - streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RB
❑A ❑A Little or no evidence of conditions that adversely affect reference interaction
❑B ❑B Moderate evidence of conditions (examples: berms, levees, down -cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of flood flows through streamside area, leaky
or intermittent bulkheads, causeways with floodplain constriction, minor ditching [including mosquito ditching])
®C ®C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision, disruption
of flood flows through streamside area] or too much floodplain/intertidal zone access [examples: impoundments, intensive
mosquito ditching]) or floodplain/intertidal zone unnaturally absent or assessment reach is a man-made feature on an
interstream divide
Water Quality Stressors - assessment reach/intertidal zone metric
Check all that apply.
®A Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
❑B Excessive sedimentation (burying of stream features or intertidal zone)
❑C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
❑D Odor (not including natural sulfide odors)
❑E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in "Notes/Sketch"
section.
❑F Livestock with access to stream or intertidal zone
❑G Excessive algae in stream or intertidal zone
❑H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc)
❑I Other: (explain in "Notes/Sketch" section)
❑J Little to no stressors
8. Recent Weather - watershed metric (skip for Tidal Marsh Streams)
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a drought.
❑A Drought conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
❑B Drought conditions and rainfall exceeding 1 inch within the last 48 hours
®C No drought conditions
9. Large or Dangerous Stream - assessment reach metric
❑Yes ®No Is stream is too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural In -stream Habitat Types - assessment reach metric
10a. ®Yes ❑No Degraded in -stream habitat over majority of the assessment reach (examples of stressors include excessive
sedimentation, mining, excavation, in -stream hardening [for example, rip -rap], recent dredging, and snagging)
(evaluate for Size 4 Coastal Plain streams only, then skip to Metric 12)
10b. Check all that occur (occurs if > 5% coverage of assessment reach) (skip for Size 4 Coastal Plain streams)
❑A Multiple aquatic macrophytes and aquatic mosses (n ❑F 5% oysters or other natural hard bottoms
(include liverworts, lichens, and algal mats) M ❑G Submerged aquatic vegetation
®B Multiple sticks and/or leaf packs and/or emergent o 2 ❑H Low -tide refugia (pools)
vegetation NC ❑I Sand bottom
❑C Multiple snags and logs (including lap trees) r ❑J 5% vertical bank along the marsh
❑D 5% undercut banks and/or root mats and/or roots ❑K Little or no habitat
in banks extend to the normal wetted perimeter
❑E Little or no habitat
*********************************REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS****—**********************
11. Bedform and Substrate - assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
11 a. ❑Yes ®No Is assessment reach in a natural sand -bed stream? (skip for Coastal Plain streams)
11 b. Bedform evaluated. Check the appropriate box(es).
®A Riffle -run section (evaluate 11c)
❑B Pool -glide section (evaluate 11d)
❑C Natural bedform absent (skip to Metric 12, Aquatic Life)
11 c. In riffle sections, check all that occur below the normal wetted perimeter of the assessment reach - whether or not submerged. Check
at least one box in each row (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams). Not Present (NP) = absent, Rare
(R) = present but < 10%, Common (C) _ > 10-40%, Abundant (A) _ > 40-70%, Predominant (P) _ > 70%. Cumulative percentages
should not exceed 100% for each assessment reach.
NP R C A P
❑ ® ❑ ❑ ❑ Bedrock/saprolite
® ❑ ❑ ❑ ❑ Boulder (256 - 4096 mm)
❑ ® ❑ ❑ ❑ Cobble (64 - 256 mm)
❑ ❑ ® ❑ ❑ Gravel (2 - 64 mm)
® ❑ ❑ ❑ ❑ Sand (.062 - 2 mm)
® ❑ ❑ ❑ ❑ Silt/clay (< 0.062 mm)
® ❑ ❑ ❑ ❑ Detritus
❑ ❑ ❑ ® ❑ Artificial (rip -rap, concrete, etc.)
11d. [-]Yes ❑No Are pools filled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)

12. Aquatic Life — assessment reach metric (skip for Tidal Marsh Streams)
12a. ®Yes ❑No Was an in -stream aquatic life assessment performed as described in the User Manual?
If No, select one of the following reasons and skip to Metric 13. ❑No Water ❑Other:
12b. ❑Yes ®No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check all that
apply. If No, skip to Metric 13.
1 >1 Numbers over columns refer to "individuals" for Size 1 and 2 streams and "taxa" for Size 3 and 4 streams.
❑ ❑Adult frogs
❑ ❑Aquatic reptiles
❑ ❑Aquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
❑ ❑Beetles
❑ ❑Caddisfly larvae (T)
❑ ❑Asian clam (Corbicula)
❑ ❑Crustacean (isopod/amphipod/crayfish/shrimp)
❑ ❑Damselfly and dragonfly larvae
❑ ❑Dipterans
❑ ❑Mayfly larvae (E)
❑ ❑Megaloptera (alderfly, fishfly, dobsonfly larvae)
❑ ❑Midges/mosquito larvae
❑ ❑Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea)
❑ ❑Mussels/Clams (not Corbicula)
❑ ❑Other fish
❑ ❑Salamanders/tadpoles
❑ ❑Snails
❑ ❑Stonefly larvae (P)
❑ ❑Tipulid larvae
❑ ❑Worms/leeches
13. Streamside Area Ground Surface Condition — streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB). Consider storage capacity with regard to both overbank flow and upland runoff.
LB RB
❑A ❑A Little or no alteration to water storage capacity over a majority of the streamside area
❑B ❑B Moderate alteration to water storage capacity over a majority of the streamside area
®C ®C Severe alteration to water storage capacity over majority of the streamside area (examples: ditches, fill, soil compaction,
livestock disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area Water Storage — streamside area metric (skip for Size 1 streams, Tidal Marsh Streams, and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
❑A ❑A Majority of streamside area with depressions able to pond water >_ 6 inches deep
❑B ❑B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
®C ®C Majority of streamside area with depressions able to pond water < 3 inches deep
15. Wetland Presence — streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB). Do not consider wetlands outside of the streamside area or within the normal
wetted perimeter of assessment reach.
LB RB
❑Y ❑Y Are wetlands present in the streamside area?
®N ®N
16. Baseflow Contributors — assessment reach metric (skip for Size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
❑A Streams and/or springs (jurisdictional discharges)
❑B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
❑C Obstruction passing flow during low -flow periods within the assessment area (beaver dam, leaky dam, bottom -release dam, weir)
❑D Evidence of bank seepage or sweating (iron in water indicates seepage)
❑E Stream bed or bank soil reduced (dig through deposited sediment if present)
®F None of the above
17. Baseflow Detractors — assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
❑A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
❑B Obstruction not passing flow during low -flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
®C Urban stream (>> 24% impervious surface for watershed)
®D Evidence that the streamside area has been modified resulting in accelerated drainage into the assessment reach
❑E Assessment reach relocated to valley edge
❑F None of the above
18. Shading — assessment reach metric (skip for Tidal Marsh Streams)
Consider aspect. Consider "leaf -on" condition.
❑A Stream shading is appropriate for stream category (may include gaps associated with natural processes)
®B Degraded (example: scattered trees)
❑C Stream shading is gone or largely absent

19. Buffer Width — streamside area metric (skip for Tidal Marsh Streams)
Consider "vegetated buffer" and "wooded buffer" separately for left bank (LB) and right bank (RB) starting at the top of bank out
to the first break.
Vegetated Wooded
LB RB LB RB
❑A ❑A ❑A ❑A >_ 100 feet wide or extends to the edge of the watershed
❑B ❑B ❑B ❑B From 50 to < 100 feet wide
❑C ❑C ❑C ❑C From 30 to < 50 feet wide
®D ®D ®D ®D From 10 to < 30 feet wide
❑E ❑E ❑E ❑E < 10 feet wide or no trees
20. Buffer Structure — streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Vegetated" Buffer Width).
LB RB
❑A ❑A Mature forest
®B ®B Non -mature woody vegetation or modified vegetation structure
❑C ❑C Herbaceous vegetation with or without a strip of trees < 10 feet wide
❑D ❑D Maintained shrubs
❑E ❑E Little or no vegetation
21. Buffer Stressors — streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB). Indicate if listed stressor abuts stream (Abuts), does not abut but is
within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If none of the following stressors occurs on either bank, check here and skip to Metric 22:
Abuts < 30 feet 30-50 feet
LB RB LB RB LB RB
❑A ❑A ❑A ❑A ❑A ❑A Row crops
❑B ❑B ❑B ❑B ❑B ❑B Maintained turf
❑C ❑C ❑C ❑C ❑C ❑C Pasture (no livestock)/commercial horticulture
❑D ❑D ❑D ❑D ❑D ❑D Pasture (active livestock use)
22. Stem Density — streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Wooded" Buffer Width).
LB RB
❑A ❑A Medium to high stem density
®B ®B Low stem density
❑C ❑C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer — streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10 feet wide.
LB RB
❑A ❑A The total length of buffer breaks is < 25 percent.
❑B ❑B The total length of buffer breaks is between 25 and 50 percent.
®C ®C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition — streamside area metric (skip for Tidal Marsh Streams)
Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contributes to
assessment reach habitat.
LB RB
❑A ❑A Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native species,
with non-native invasive species absent or sparse.
❑B ❑B Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear -cutting or clearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
®C ®C Vegetation is severely disturbed in terms of species diversity or proportions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non -characteristic species or communities inappropriately composed of a single species or no vegetation.
25. Conductivity — assessment reach metric (skip for all Coastal Plain streams)
25a. ❑Yes ®No Was conductivity measurement recorded?
If No, select one of the following reasons. ❑No Water ®Other:
25b. Check the box corresponding to the conductivity measurement (units of microsiemens per centimeter).
❑A < 46 ❑ B 46 to < 67 ❑ C 67 to < 79 ❑ D 79 to < 230 ❑ E >_ 230
Notes/Sketch:
Stream is located in a heavily developed and urban environment with significant amounts of debris. The upstream portion has several trees with
higher percentage of vegetation cover and trees. The lower portion has no tree cover and the buffer consists of invasive species.

Draft INC SAM Stream Rating Sheet
Accompanies User Manual Version 2.1
Stream Site Name Patterson Culvert Date of Assessment
03/30/2021
Replacement
Stream Category Pb2 Assessor Name/Organization
Benjamin Burdette/HDR
Notes of Field Assessment Form (Y/N)
YES
Presence of regulatory considerations (Y/N)
NO
Additional stream information/supplementary measurements included (Y/N)
YES
NC SAM feature type (perennial, intermittent, Tidal Marsh Stream)
Perennial
USACE/ NCDWR
Function Class Rating Summary All
Streams Intermittent
(1) Hydrology
LOW
(2) Baseflow
MEDIUM
(2) Flood Flow
LOW
(3) Streamside Area Attenuation
LOW
(4) Floodplain Access
LOW
(4) Wooded Riparian Buffer
LOW
(4) Microtopography
NA
(3) Stream Stability
MEDIUM
(4) Channel Stability
MEDIUM
(4) Sediment Transport
HIGH
(4) Stream Geomorphology
MEDIUM
(2) Stream/Intertidal Zone Interaction
NA
(2) Longitudinal Tidal Flow
NA
(2) Tidal Marsh Stream Stability
NA
(3) Tidal Marsh Channel Stability
NA
(3) Tidal Marsh Stream Geomorphology
NA
(1) Water Quality
LOW
(2) Baseflow
MEDIUM
(2) Streamside Area Vegetation
LOW
(3) Upland Pollutant Filtration
LOW
(3) Thermoregulation
MEDIUM
(2) Indicators of Stressors
NO
(2) Aquatic Life Tolerance
LOW
(2) Intertidal Zone Filtration
NA
(1) Habitat
LOW
(2) In -stream Habitat
LOW
(3) Baseflow
MEDIUM
(3) Substrate
LOW
(3) Stream Stability
MEDIUM
(3) In -stream Habitat
LOW
(2) Stream -side Habitat
LOW
(3) Stream -side Habitat
LOW
(3) Thermoregulation
MEDIUM
(2) Tidal Marsh In -stream Habitat
NA
(3) Flow Restriction
NA
(3) Tidal Marsh Stream Stability
NA
(4) Tidal Marsh Channel Stability
NA
(4) Tidal Marsh Stream Geomorphology
NA
(3) Tidal Marsh In -stream Habitat
NA
(2) Intertidal Zone
NA
Overall
LOW

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Appendix D
Site Photographs

Patterson Avenue Emergency Repair Project I Forsyth County, North Carolina
Preliminary Jurisdictional Determination Request
Photograph 1 - North School Branch (Stream 1), Perennial Stream, Facing West
Photograph 1 - North School Branch (Stream 1), Perennial Stream, Facing East

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Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:*
Is this a transportation project?*
Benjamin Burdette
[e-mail]
City of Winston Salem
Patterson Culvert Emergency Replacement Project
Forsyth
Street Address
1200 N Patterson Avenue
Address Line 2
aty
Winston Salem
Postal / Zip axle
27101
C Yes c: No
Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - F- 401 Water Quality Certification -
Regular Express
F- Individual Permit F- Modification
F- Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (: No
State / Province / Pegion
NC
Country
USA
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information.*
The Patterson Avenue Emergency Repair project is in response to
culvert and roadway slope failures occurring at the North Patterson
Avenue crossing over the North School Branch stream. The City of
Winston-Salem desires to replace the e)asting culvert and stabilize
the surrounding area. According to the preliminary 60% plans, this
replacement and repair would constitute appro)amately 13' of
streambed loss from additional culvert and 32' from additional riprap.
Current stream banks are suffering from high degrees of erosion and
the poor conditions of the e)asting culverts are resulting in flooding
issues.
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.

• I understand by signing this form that Icannot submit myapplication until 30 calendar days after this pre -filing
meeting request.
• I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature *
Submittal Date 7/16/2021