20140814 Ver 1_401 Application_20140714

KL E/NFEL DER
Bright People. Right Solutions.
17 July 2014
Mr. Craig Brown
USACE Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Ste 105
Raleigh, North Carolina 27587
Ms. Karen Higgins, Supervisor
NC Division of Water Resources 401 Permits
1617 Mail Service Center
Raleigh, North Carolina 27699 -1617
RE: Falls Road Baptist Church, Rocky Mount, Nash County, North Carolina.
Dear Craig and Karen
Kleinfelder is submitting this Pre - Construction Notification for your consideration in issuing Section
404/401 permits and Riparian Buffer Authorization associated with the proposed Falls Road Baptist
Church in Rocky Mount, NC (Nash County).
We respectfully request your review and correspondence relating to this application at your earliest
opportunities. This application was prepared following the PCN format, with supplemental responses
provided in an attachment.
Thank you both in advance for your time and consideration of this request. We remain available to
provide additional information or clarifications if and as needed.
Regards,
Lh ^ -.
Christopher Hopper, CFM
Environmental Scientist
3500 Gateway Centre Blvd., Ste 200
Morrisville, NC 27560
of 919 - 755 -5011 x103
cl 919 - 524 -8370
fj 919 -755 -1414
RECEIVED
JUL 31 1014
DENR -LAND QUALITY
STORMWATER PERMITTING
Kleinfelder, Inc., Morrisville, NC 27560 p 1919,755.5011 f 1919.755.1414

aF WATF9 Office Use Only: AID
� p y:
y 2 0 1 4 0 8 1 4 Corps action ID no.
a < DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1a.
Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number: 3886
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X No
1d.
Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑X Riparian Buffer Authorization
le.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes NX No
For the record only for Corps Permit:
N Yes X❑ No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
N Yes ❑X No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑ Yes X❑ No
1h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a.
Name of project:
Falls Road Baptist Church
2b.
County:
Nash
2c.
Nearest municipality / town:
Rocky Mount
2d.
Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state project no:
N/A
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Falls Road Baptist Church
3b.
Deed Book and Page No.
RECEIVED
3c.
Responsible Party (for LLC if
applicable):
1 7014
3d.
Street address:
3144 Benvenue Road
3e.
City, state, zip:
Rocky Mount, NC 27804
STORMW*ER PERMITTING
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant, Information (if different from owner)
4a
Applicant is
® Agent ❑ Other, specify
4b
Name
Chris Hopper
4c
Business name
(if applicable)
Kleinfelder, Inc
4d
Street address
3500 Gateway Centre Blvd , Ste 200
4e
City, state, zip
Morrisville, NC 27560
4f
Telephone trio
919- 524 -8370
4g
Fax no
919- 755 -1414
4h
Email address
chopper @kleinfelder com
S.
Agent/Consultant Information (if applicable)
5a
Name
Same as applicant
5b
Business name
(if applicable)
5c
Street address
5d
City, state, zip
5e
Telephone no
5f
Fax no
5g
Email address-
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a
Property identification no (tax PIN or parcel ID)
384200505943 (Nash County)
1b
Site coordinates (rn decimalAegrees)
I Latitude- 36 000156 Longitude -77 831917
1c
Property size
481 acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project
UT Horn Beam Swamp
2b
Water Quality Classification of nearest receiving water
C,NSW
2c
River basin
Tar-Pamlico
3.
Project Description
3a 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'is currently'in agriculture, recreation, and forest land uses,
3b
List the total estimated acreage of all existing wetlands on the property 7 85
3c
List the total estimated linear feet of all existing streams (intermittent,and perennial) on the property 4,455
3d Explain the purpose of the proposed project
See attached
3e Describe the overall project in detail, including the type of equipment to be, used
See attached
4.
Jurisdictional Determinations
4a
Have ijunsdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
ro ect, includin all nor phases) in the past?
❑X Yes ❑ No ❑ Unknown
Comments Thomas Brown, 02 Jan 14 (see notes)
4b
If the Corps made the jurisdictional determination, what type
of determination was made?
Preliminary ❑ Final
4c
If yes, who delineated the jurisdictional areas?
Name (if known) Christopher, Hopper, Kleinfelder
Agency /Consultant Company Kleinfelder, Inc
Other
4d If yes, list the dates of the Corps'junsdictional determinations or State determinations and attach,documentatiorr
See attached
5.
Project History
5a
Have permits or certifications been requested or obtained for
this project'(including ,all prior phases) in the past?
❑ Yes ❑X No ❑ Unknown
5b
If yes, explain in detail,according to "help file" instructions
6.
Future ProjecttPlans
6a
Is this a phased project?
❑Yes ❑X No
6b
If yes, explain
Page 3 of 10
PCN Form — Version 1 4 January 2009

C. Proposed Impacts Inventory
1 Impacts Summary
1a Which sections were completed below for your project (check all.that apply)
❑X Wetlands ❑ Streams — tributaries ❑X Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the.site, then complete this question for each wetland area,impacted
2a
Wetland, impact
number
Permanent (P) or
Temporary T
2b
Type of impact
2c
Type,of wetland
2d
Forested
2e
Type of jurisdiction
Corps (404,10), or
DWQ (401, other)
2f
Area of
impact
(acres)
W1 P
Fill
Non -Tidal Freshwater Marsh
No
Corps
0 027
W2'
Choose one _
Choose,one
Yes/No
W3
Choose one
Choose one
Yes/No
W4
Choose one
Choose one
Yes /No
W5
Choose one
Choose,one
Yes /No
W6
Choose one
Choose one
Yes/No
2g Total Wetland Impacts:
0 027
2h, Comments
Widening and paving existing gravel driveway
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question fonall strearn sites impacted
3a
Stream impact
number
Permanent (P) or
Temporary (T)
3b
Type of impact
3c
Stream name
3d
Perennial (PER) or
intermittent (INT)?
3e
Type of
jurisdiction
3f
Average
stream
width
(feet)
3g
Impact
length
(linear
feet)
S1
Choose,one
S2
Choose one
S3
Choose one
S4
Choose one
-
S5
Choose,one
S6
Choose one
3h Total stream and tributary impacts
31 Comments
Page 4 of 10
PCN Form — Version 1 4 January 2009

4. Open Water Impacts
If'there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the.Atlantic Ocean,'or any other open water of
the U S then'indiv ually list all open water impacts below
4a
Open water
impact number
Permanent (P) or
Temporary T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody
type
4e
Area of impact (acres)
01
Choose,one
Choose
02
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f Total open water impacts
4g Comments
5. Pond or Lake Construction
If pond-or lake construction proposed, the complete the chart below
5a
Pond ID number
5b
Proposed use or
purpose'of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f Total:
5g Comments
5h, Is a dam high hazard,permit regwred?
❑ Yes ❑ No If,yes, permit ID'no
51 Expected pond surface area (acres)
51 Size of pond watershed (acres) ,
5k Method of construction
6. Buffer Impacts (for DWQ)
If prolect,will impact a;protectederipanan buffer, then complete the chart below If yes, then individually, list all buffer impacts
below If an impacts require mite ation, then, ou MUST fill out;Section D of this4orm
,
6a Project is in which protected basing
❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other-
6b
Buffer Impact,
number—
Permanent (P) or
Temporary T
6c
Reason for impact
6d
Stream name
6e
Buffer
mitigation
required?
6f
Zone 1
impact
(square
feet)feet
6g
Zone 2
impact
(square
B1 P
Dnvewaq'Improvements
UT Hom Beam Swamp,
No
335
1,827
B2 P
Sewerlme Corndor (15')
UT Hom Beam Swamp
No
1,095
822
B3 T
Construction Cor (40')
UT Hom Beam Swamp
No
2,055
1,576
B4 -
Yes/No
B5 -
Yes /No
B6 -
Yes /No
6h Total Buffer Impacts:
3,485
4,225
61 Comments See attached
Page 5 of 10

U. Impact Justification and Mitigation
1. Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
See attached
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
See attached
2. Compensatory Wil ation 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?
❑ Yes ❑X No
2b If yes, mitigation'is required '. by, (check all that apply)
❑ DWQ ❑Corps
2c If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Miti abon,Bank,
3a Name of Mitigation Bank N/A
3b Credits Purchased (attach receipt and letter)
Type Choose one
Type Choose one
Type Choose one
Quantity
Quantity
Quantity
3c Comments
4. Complete if Making a4Pa ment,to In -lieu Fee Program
4a Approval letter from in -lieu fee program is attached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation, stream ;temperaturem
Choose one
4d Buffer mitigation requested,(DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non - npanan wetland mitigation requested,
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
5. Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan
Page 6 of 10
PCN Form — Version 1 4 January 2009

6. Buffer'Mitigation (State,Regulated Riparian Buffer'Rules)— required'by'DWQ
6a Will the project result in an impact within a protected npanan` buffer that requires
buffer mitigation?
❑ Yes No
'6b If yes; then identify the square,feet of impact to each zone of the, riparian buffer,that requires mitigation Calculate they
amount of mitigation required
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
3'(2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required:
6g If buffer mitigation is kequired, discuss what type of mitigation is proposed (e g , payment'to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund)
6h Comments
Page 7 of 10

E. Stormwater Management and'Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a Does the project include or is it adjacent to protected npanan buffers identified
Yes ❑ No
within one of the. NC Riparian Buffer Protection Rules?
1b ,If yes,, then is a diffuse flow, planlincluded? If no, explain why
No discharge is proposed' through riparian buffers A grassed swale will direct runoff away from the
buffers
❑ Yes ❑X No
protected buffer, into upstream marsh wetlands before entering the stream or
2. Stormwater Management Plan
2a What is the overall percent'imperviousness of this project?
_
57%
2b Does this project require a Stormwater Management Plan?
❑ Yes ❑X No
2c If this project DOES NOT require a Stormwater Management Plan, explain why
The post - construction impervious surface area of 5 7% of the site, is not abovd`the 15% threshold set by Sectton,802 of(the City,of'Rocky Mount,
Code The Tar -Pam Nutrient Buydown Worksheet for this project also found that nitrogen and phosphorus contributions (1 38 Ib /acJyr, and 0,28 lb/6c/
yr, respectively) are below thresholds
b
2d If this project DOES,regwre a Stormwater Management Plan, then provide a brief, narrative description of,the plan
2e Who will be responsible for the review of the Stormwater Management Plans
,City of Rocky Mount
3. Certified'Local Government,StormwaterRevrew
3a In which local government's jurisdiction is this project?
❑X Phase II
❑X NSW
3b Which of the following locally - implemented , stormwater management programs
E] USMP
apply (check all that apply)
❑ Water,Supply Watershed
❑ Other
3c Has the'approved Stormwater, Management Plan with proof of approval been
❑ Yes ® No
attached9
4. DWQ Stormwater Program Review
❑Coastal counties
[--IHQW
4a Which of the following state - implemented stormwater management programs apply
L]ORW
(check all that apply)
❑ Session, Law,2006 -246
❑ Other
4b 'Has the approved Stormwater`Management Plan with proof of approval been
0 Yes ❑X No
attached?
5. DWQ,401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b Haverall of the =401 Unit submittal regwrementsbeen mete
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1 4' January 2009

F. Supplementary Information
1. Environmental Documentation, (DWQ Requirement)
la Does the project involve•an expenditure of public (federal /state /local) funds or,the
❑ Yes ❑X No
use of public (federal /state) land?
1 b 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
❑ Yes ❑X No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c If you answered" "yes" to the,above, has the document review been finalized by the
'State Clearing House? (If so, attach a copy of the NEPA or'SEPA final approval
❑ Yes ❑X No
letter)
Comments
2. Violations (DWQ Requirement)
2a Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500), Isolated
Wetland Rules (15A NCAC 2H 1300), DWQ Surface Water or Wetland Standards,
El Yes ❑X No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b Is this aniafter- the -fact permit application?
❑Yes, ❑X No
2c If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s)
3. Cumulative Impactsi(DWQ Requirement)
3a WIII this project (based',on past and reasonably anticipated future impacts) result in
❑ Yes ® No
additionalldevelopment, which could impact nearby downstream;water,quality?
3b If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered "no," provide a short narrative description
4. Sewage Disposal (DWQ Requirement)
4a Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the,sublect facildy
Wastewater generated at the church will be sent via gravity flow to an existing 6 -inch line under Thomas A Betts Parkway Wastewater will be
transferred to the Tar River Regional Wastewater Treatment Plant for treatment The, plant operates under NPDES Permit #NC0030317, and is
permitted to treat -21 million gallons per day Treatment processes include pure oxygen activated sludge using biological,nutnent removal Treated
wastewater is discharged to the Tar River, and waste sludgeiis land applied after aerobic digestion to permitted parameters
Page 9 of 10
PCN Form — Version 1 4 January 2009

'5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occurlin or near an area with federally protected species or
❑ Yes ❑X No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ❑X No
impacts?
5c If yes, indicate the USFWS Field Office you have contacted
Raleigh
5d What data, sources did you use to,determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Species were identified using the USFWS website (http / /www fws gov /raleigh /species /cntylist/nash html), supplemented by�NCNHP data Field
investigations were conducted
6. Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b What data sources did, you use to determine whether your site would impact Essential Fish Habitat?
NOAA Habitat Conservation /Habdatprotection, Essential Fish HabitatlMapper v3 0 (http / /www_habdat noaa gov /protection /efh /habitatmapper html)
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
❑ Yes ❑X No
status (e g , National Historic Trust,designation or properties significant in
North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would,impact histonc or archeological resources?
North Carolina, State Historic +Preservation Office (HPOWEB GIS Service), General Audience http / /gis ncdcrgov /hpoweb/
8. Flood Zone Designation (Corps, Requirement)
8a Will this project occur in a FEMA- designated 100 -year floodplain?
❑ Yes ❑X No
8b If yes, explain how project meets FEMA requirements
Flood Risk, information � System (http //iris nc govhns/Home aspx ?ST =NC)
8c What source(s) did you use to make the'floodplain determination?
FEMA FIRM Panel 37203842300J
Applicant/Agent's Printed Name
Date
Applicant/ gent's Signature
(Agent's signature is valid,only if awauthonzation
'letter from;the applicant is provided
Page 10 of 10

Attachments
PCN Text Supplements
Preliminary JD Request Form and Wetland Determination Data Sheets
Figures
1. Project Location Map
2. Project Overview Map
3. NWP 14 Impact Illustration
4. Sewer Line Buffer Impact Illustration
Appendices
A. Stream and Wetland Verification Documentation
B. Construction Plans for Falls Road Baptist Church
C. Construction Plans for Falls Road Baptist Church Sewer Extension

PCN Attachments and Text Supplements

Introduction
Falls Road Baptist Church is�proposing -a new church in Rocky Mount, North Carolina. The facility will be
located on,ezisting'agricultural land and recreational,baseball fields on an otherwise undeveloped tract.
An existing gravel driveway across jurisdictional wetlands will be expanded and paved. To provide the
facility'with- sanitary sewer service, a new gravity sewer line will run eastward (down slope) and connect
with an existing, manhole on the northern shoulder of Thomas A Betts Parkway The sewer line will need
to cross an unnamed tributary of Horn Beam Swamp (C, NSW,). To maintain minimum slopes'and
provide adequate drainage without impacting the stream, this crossing will be elevated on concrete
piers installed in uplands on either side of the feature Rip -Rap will be used on adjacent upland slopes
to provide stabilization; however none will be used in or adjacent to the stream.
Kleinfelder conducted wetland delineations and surface water identifications on the site. The extents of
these features were confirmed by the NC'Division of Water Resources on 19 December 2013, and by the
US Army Corps of Engineers on 02 January 2014
Falls Road Baptist Church,is requestmg,authorization to construct the,driyeway improvements utilizing,
Nationwide Permit'14 and North Carolina's General Certification 3886 The driveway improvements and
sanitary sewer line corridor will both impact riparian buffers Authorization to construct these
improvements is also being requested from the NC'Division of Water Resources pursuant to 15A NCAC
02B.0259, Tar Pamlico River Basin Nutrient Sensitive Waters management Strategy
B. 3d. Purpose of Proposed Project:
To construct the Falls Road Baptist Church property, and provide It with gravity sanitary sewer service
connected with the Rocky Mount, NC collection system
B. 3e. Overall Project in Detail:
The project will'mclude the,construction of a church, and,sanitary sewer service,gravity connection to
the Rocky'Mount-NC collection system
The proposed Falls Road Baptist Church will be a 13;076 square foot structure, occupying the central
portion of the 48.1 acre site The total disturbed area,, including entry drive and parking facilities, will be
8.7 acres Complete plan sheets for the proposed church are provided in Appendix B.
The existing driveway from Benvenue Road in Rocky Mount, NC will be expanded and paved to allow
vehicular access to the church This will also allow the project to minimize wetland impacts, and utilize
existing culverts to avoid impacts to the stream channel. The driveway will be 25 -feet wide, and run
northeast to the center of the property where current agriculture and recreation uses are on- going, It is
anticipated that,agricultural uses will,continue on undisturbed portions of the property. Construction
vehicles to be used include the standard site preparation and,construction equipment These may
include bulldozer, backhoe, bucket loader, and general construction vehicles.

Construction of the church itself may begin before approval of this permit is'issued. Access to the
upland construction site would utilize the existing driveway in existing high- ground with no impact on
stream, wetland, or,npanan buffer,areas. The approach was verified via email with the US Army Corps
of Engineers,(ACOE) and North Carolina Division of Water Resources (NCDWR).
Extending east from the project property toward an existing manhole along Thomas A. Betts Parkway
will be a 40 -foot wide temporary construction corridor to install a new sanitary sewer line. ,Installation is
expected to require use of a backhoe, and general construction vehicles. Complete plan,sheets for the
proposed sanitary sewer line are provided in Appendix C.
B.44- Jurisdictional Determinations
Onr02 January 2014, Thomas Brown with the Wilmington District of the,ACOE visited the property and
verified wetland delineations prepared by-Kleinfelder On `18 December 2013, James Graham with the
NCDWR,visited the property and verified stream determinations prepared by Kleinfelder. No PJD has
been issued, but,ver,ifications have been secured'from both, agencies Copies of the site visit request for
both the ACOE and NCDWR are provided in Appendix A
D.1a. Design measures to minimize'impacts
Church Property The church building and parking areas will be situated on the highest ground available
on °the property, providing hundreds of feet of agricultural and maintained grass between it and
Jurisdictional waters and NCDWR riparian buffers. The proposed access drive will utilize the existing
gravel drive onto the property from Benvenue Road, reducing wetland impacts to 0.027 acre (1,161
square feet). The drive will utilize existing concrete culverts without disturbance to the stream.
Riparian buffer impacts will be limited to converting gravel to pavement, and improve on current
conditions by directing runoff up- stream through,a grass swale into marsh wetlands prior to entering
the stream.
Sanitary Sewer line: To maintain minimum slopes for sewer flow, placement of the sewer line is limited
to open -cut burial across the stream with four inches of cover, or an aerial crossing on piers. Project
designers opted to utilize piers.on either side of the stream channel This will eliminate the need to
disturb,the stream or its banks. It will'also avoid concerns for stream down - cutting -that would expose
the sanitary sewer, block aquatic life passage, and pose a risk to downstream water quality.
D.1b. Construction measures to minimize impacts
All erosion and sediment control devices will be installed prior to ground disturbing activities. If church
construction begins prior to approval of stream and wetland impact permits, the existing access drive
and all construction areas will be lined with sediment fencing to keep construction vehicles out,of
jurisdictional,areas and prevent offsite migration of sediment.
Riparian Buffers will be lined with orange construction fencing throughout site development. The
existing gravel,road inside the,riparian buffers,will be abandoned.

Contractors, have been instructed to verify ACOE and,NCDWR permits have been secured before
beginning work on the access drive or sewer line. To the extent feasible, construction in jurisdictional
areas will occur in a,single day and during dry weather All construction activities will be in accordance
With the requirements of nationwide, permits 12,and 14, their corresponding NCDWR certifications 3884
and 3886,.and the Tar - Pamlico River nutrient sensitive riparian buffer regulations
C.6i. Buffer Impact - Comments
Driveway'(131) - Nolemporary impact,to,riparian buffers for the,dnveway is listed. The area is currently
maintained in herbaceous vegetation and no additional impact will occur.
Sewer "Line (132/3) - The temporary construction corridor will, not exceed 40 -feet in width.

Preliminary JD Request Form and Wetland Determination Data Sheets

Preliminary Jurisdictibnal Determination Form
BACKGROUND INFORMATION
A Report Completion Date for Preliminary Jurisdictional Determination (JD).
B Name and Address of person requesting Preliminary JD-
Christopher Hopper, Kleinfelder Inc.
3500 Gateway Centre Blvd., Ste 200, Morrisville NC 27560
C District Office, File Name, and Number:
D. Project Location(s) and Background Information:
Site, Number
Latitude
Longitude
Cowardin
Class
Estimated
amount,of
aquatic
resource in
review area
Class of
Aquatic
Resource
W1 (Driveway)
35.998045
-77; 833261
PEM
0 026
Non - Section
10, Non Tidal
.Name of any water bodies on the site that have been identified as Section 10 waters-
Tidal. None
Non - Tidal. UT Horn Beam Swamp, Class C; NSW, Tar - Pamlico Rivet Basin
E,. Review performed for Site Evaluation (Check all that apply)
❑ Office (Desk) Determination Date.
0 Field, Determination. Date(s): 02'January 2014 (Thomas Brown)
SUPPORTING DATA
Data reviewed for preliminary JD (Check;all -that apply — checked items should be °included in case file
and, where checked and requested, appropriately reference sources below).
Z Maps, plans, plots, or plat submitted on behalf of the applicant /consultant
0 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 Hydrological Atlas
❑ USGS HND data
❑ USGS 8 and 12 digit HUC maps
Z'U.S Geological ^Survey map(s) Cite scale & quad name
Drake, NC USGS 7.5 min quadrangle
Rocky Mount, NC USGS 7.5 min quadrangle
Z USDA Natural Resources Conservation Service Soil Survey: Citation
Nash County Soil Survey, Map Sheets 5 and 9
❑ National wetlands inventory map(s) Cite name
❑'State /Local wetland inventory map(s)
❑ FEMA /FIRM maps
❑ 100 -year Floodplain Elevation is
❑ Photographs
❑ Aerial (Name & Date)
❑ Other,(Name & Date)
(National Geodetic Vertical Datum of'1929)
❑ Previous Determinations) File no and date of response letter=
❑ "Other Information (please specify)
Signature and Date of Signature,and date of
Regulatory Project Manager person requesting preliminary JD
(REQUIRED) (REQUIRED, unless obtaining
The signature is impracticable)

AGENT AUTHoRfZAT1ON FORM
PROPERTY LEGAL DESCRIPTION:
Lot,No• ^fd /A
Plan NO: _N /A Parcel ID: 384200505943 (Nash Co.)
Street Address _3144 Benvenue,Road, Rocky Mount NC 27804' (Project Property)
722,Falls Road, Rocky Mount NC 27804 (Owner Address)
Owner Name (printed): Jalls Road Baptist Church
Owner Name:_
Telephone No:
The undersigned, registered property owners of the,above noted property do hereby authorize
Christopher Hopper, of Kleinfelder Southeast to act on my behalf and take all actions necessary for the
processing „issuance�and acceptance of a4urisdictional Determination and,any required Clean Water
Act Section 404 /401 Permits to construct the project, North Carolina.
We hereby certify the above information submitted in this request is,true and accurate to the best of
our knowledge,
Au�t(h�orized Signature:
Date: m_ - t � 13

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site Falls Road Baptist Church City /County Rocky Mount/Nash Sampling Date TNov 13
Applicant/Owner Falls Road Baptist Church State NC Sampling Point WTL M1
Investigator(s) Chris Hopper, Kleinfeld'er Southeast Section, Township, Range Rocky Mount/Drake NC, IJSGS,Quads
Landform (htllslope, terrace, etc -) headwater Local relief (concave, convex, none) concave Slope ( %) 2 -6
Subregion (LRR or MLRA) LRR T Lat, 36 001398 Long -77 $29$49 Datum NAD83
Sod Map Unit Name Norfolk Wedowee complex NWI classification PF01
Are climatic /'hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks)
Are Vegetation Sod or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No
Are Vegetation Sod 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 X No Is the Sampled Area
Hydric Soil Present? Yes X No within a Wetland? Yes X No
Wetland Hydrology Present? Yes X No _
Remarks
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators,(mmimum of two required)
❑ Surface Sod Cracks (136)
❑ Sparsely Vegetated, Concave Surface (138)
Primary Indicators (minimum of one,is required, check all that agoly)
Surface Water (Al) El Aquatic;Fauna (1313)
p❑
LJ
High Water Table (A2)
Ir---TI Mari Deposits (B15) (LRR U)
❑ Drainage Patterns (610)
❑
Saturation (A3)
Hydrogen Suffide Odor (C1)
❑ Moss Trim Lines (B16)
Water'Marks (61)
TQ
Q Oxidized Rhiiospheresalong Living Roots (C3)
0 Dry- Season Water Table (C2)
Sediment Deposits (62)
LJ Presence of Reduced Iron (C4)
0 Crayfish Burrows (C8)
_
Drift Deposits (63)
_Q Recent Iron Reduction in Tilled Sods (C6_)
❑ Saturation Visible on,Aenal Imagery (C9)
EI--lI
Algal Matior Crust (B4)
❑ Thin Muck Surface (C7)
❑ Geomorphic Position (D2)
1_L
Iron Deposits (65)
Other (Explain in Remarks)
❑ Shallow Aqwtard (133)
Q
Inundation Visible on Aerial Imagery (137)
❑ FAC- Neutral Test (D5)
Q
Water - Stained Leaves (B9)
II Sphagnum moss (D8) (LRR T, U)
Field Observations:
Surface Water Present? Yes
No X Depth (inches)
Water Table Present? Yes
No X Depth (inches)
Saturation Presents Yes
No X Depth (inches)
Wetland Hydrology Present? Yes X No
i

VEGETATION (Four Strata) — Use scientific narres,of'plants
Tree Stratum (Plot size 30x30 )
1 Liquidambar styraaflua
2
3
4
5
6
7
8
Sampling Point WTL M1
Absolute Dominant Indicator
Dominance Test worksheet•
2
% Cover Species? Status
30 X FAC
Number of Dominant Species
That Are OBL, FACW, or FAC
7
Juncas effusus
Total Number of Dominant
4
5
Toxicodendron radicans
Species Across All Strata
8
Percent of Dominant Species
That Are OBL, FACW, or FAC
88
Prevalence, index, avorksheet-
8
Total %Cover of
Multiply by
OBL species
x 1 =
30 = ,Total Cover
10
11
FACW species
x2=
(A)
(B)
(A[B)
50% of total cover 20% of total cover
Saolmn /Shrub Stratum (Plot size 30x30 ) FAC species x 3 =
1 Liqwdambar styraaflua 10 X FAC, FACU species x4=
2 Acer rubrum 5 FAC' UPL species x 5 =
3 Ligustrum sinense 10 X FACU Column Totals (A) (B)
4 Acer negundo 15 X FAC
5
6
7
8
40 Total,Cover
20 °k of total cover
50% of total cover
Herb Stratum (Plot size 30x30 )
1 Boehmena cylindnca
5
2
m
Microstegeu vimmium
50
3
Juncas effusus
10
4
5
Toxicodendron radicans
20
6
7
8
9
10
11
_
12
50% of total cover
Woody Vine.Stratum (Plot size, 30x30 )
1 Toxicodendron'radicans
2 Lonicera japonica
3 Smilax rotundifolia
4
5
Prevalence Index = B/A =
Hydrophytic Vegetation' Indicators:
IIn 1 - Rapid Test for'Hydrophytic Vegetation
2 - Dominance Test is >50%
II 3 - Prevalence Index is s3 0'
Probiematic,Hydrophytic Vegetation' (Explain)
'Indicators of hydnc soil and wetland hydrology must
FACW be present, unless disturbed or problematic
X FAC Definitions of Four Vegetation Strata.
FAC 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 3 +m DBH and greater than 3 28 ft (1 m)`tall
85 = Total Cover
20% of total cover-
5 X FAC
5 X FAC
5 X FAC
Herb — All herbaceous (non - woody) plants, regardless
of size, and woody plants less than 3 28 ft tali
Wo m
ody vine — All woody ves,greater than 3 28 ft in
height
Hydrophytic
15 = Total'Covef Vegetation
50% of total cover- 20 %' of total cover Present?
hological. adaptations below)
Yes X No
r
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2 0

SOIL
Profile Description: (Describe to the depth needed to document the, indicator -or confirm the absence of i
Sampling Point WTL M1
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type Loc2 Texture Remarks
0 -9 10YR 6/1 100
9 -14+ 10YR 5/3' 80 5Y 7/4 20
M= Matroc
Hydric Sod Indicators:, (Applicable to,all LRRs,,unless otherwise noted') Jndicators for Problematic, Hydric Soils':
Histosoi (Al)
Polyvalue Below Surface (S8) (LRR'S, T, U)
❑
1 cm Muck (A9) (L "RR,O)
Histic Epipedon,(A2)
H
Thin Dark Surface (S9) (LRR S, T, U)
B
2 cm Muck (A10) (LRR S)
Black Histic (A3)
Loamy Mucky Mineral (F1) (LRR O)
Reduced Vertic (F18) (outside MLRA 150A,B)
Hydrogen Sulfide (A4)
Loamy,Gleyed Matrix (F2)
u
Piedmont Floodplam Sods (F19) (LRR P, S, T)
Stratified Layers (A5)
✓
Depleted ; Matrix, (F3)
Anomalous Bright Loamy Sods (F20)
Organic Bodies (A6) (LRR P, T, U)
Redox Dark Surface (F6)
(MLRA 1536)
5 cm Mucky Mineral (A7) (LRR P, T, U)
Depleted Dark Surface (F7)
Red Parent Material (TF2)
Muck Presence (A8) (LRR U)
H
Redox Depressions (178)
u Very Shallow Dark Surface (TF12)
1 �cm Muck (A9) (LRR P, T)
Marl (F10) (LRR`U)
1:1, Other (Explain, in Remarks)
Depleted Below Dark Surface (A11)
Depleted Ochnc (F11) (MLRA 151)
Thick Dark Surface (Al2)
Q
Iron - Manganese Masses (F12) (LRR O, P, T)
3Indicators of hydrophytic vegetation and
Coast Praine Redox (A16) (hill-RA 150A)
0
Umbnc Surface (F13) (LRR P, T, U)
wetland hydrology must be present,
Sandy Mucky Mineral (S1) (LRR O, S)
Delta'Ochnc (F17) (MLRA151)
unless disturbed,or problematic
Sandy;Gleyed Matrix (S4)
❑
Reduced Vertic (F18) (MLRA 150A, 150B)
Sandy Redox (S5)
Piedmont Floodplain'Sotls (1719) (MLRA 149A)
Stripped Matrix (S6)
Anomalous Bright Loamy Sods (F20) (MLRA 149A, 153C, 153D)
Dark Surface,(S7,) (LRR P, S, T, U)
Type
Depth (inches)
Remarks
Hydric Soil Present? Yes X No
US Arty Corps of Engineers Atlantic and`Gulf Coastal Plain Region — Version 2 0

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site Falls Road,Baptist Church City /County Rocky Mount/Nash Sampling,Date 7 Nov 13
Applicant/Owner Falls Road Baptist Church 'State NC Sampling Point WTL M1
Investigator(s) Chris Hopper, klernfelder Southeast Section, Township, Range Rocky Mount/Drake NC, USGS Quads
Landform (hillslope, terrace, etc)- headwater Local relief (concave, convex, none) concave Slope ( %) 2 -6
Subregion (LRR or MLRA) LRR T Lat 36 001398 Long -77 829849 Datum NAD83
Soil Map Unit Name Norfolk Wedowee complex NWl classification PF01
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 , Sod ,.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 X No Is the,Sampled Area
Hydnc,Soil Present? Yes X No wrthm,a Wetland? Yes X No
Wetland' Hydrology Present? Yes X No
Remarks
HYDROLOGY
Wetland Hydrology Indicators:
Secondary ' Indicators (minimum of•two.reauired)
❑ Surface Soil,Cracks (B6)
❑ Sparsely Vegetated Concave Surface (68)
Primary Indicators (minimum, of, one, is reawred, check all that aooly)
❑
Surface Water (Al) ❑-f Aquatic Fauna (813)
❑
High Water Table,(A2)
1
-Ir Marl Deposits (B15) (LRR U)
❑ Drainage Patterns (610)
❑
Saturation (A3)
1L--
I� -,-7I Hydrogen Sulfide Odor (Cl)
Moss Tnm °Lines (816)
❑_
Water'M arks, (B1)
Oxidized Rhizospheres along Living Roots (C3) '❑
Dry- Season Water Table (C2)
Sediment'Deposds (B2)
111°°Jii
1L--Jr Presence of Reduced Iron (C4)
LJ Recent Iron.Reduction in Tilled Sods (C6)
21 Crayfish Burrows,(C8)
❑ Saturation Visible on Aerial Imagery (C9)
Q
Dnft'Deposits (B3)
Algal Mat or Crust,(B4)
❑ Thin Muck Surface (C7)
II Geomorphic Position (D2)
Q
Iron Deposits (B5)
0 Other (Explain )n Remarks)
❑ Shallow Aqwtard (D3)
❑
Inundation Visible on,Aenal Imagery (B7)
❑ FAC- Neutral Test (D5)
❑
Water - Stained Leaves (B9)
❑ Sphagnum moss (D8) (LRR T, U)
_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 X No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available
Remarks
US Army Corps of Engineers Atlantic and Gulf Coastal Plam`Region — Version 2 0

VEGETATION (Four Strata) — Use scientific names of plants
Sampling Point WTL M1'
Remarks (If observed, list morphological adaptations below)
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2 0
Absolute Dominant' Indicator
Dominance'Test worksheet*
Tree Stratum (Plot size _ 30x30
)
% Cover Species Status
Number of Dominant Species
1 Liquidambar,styraciflua
30 X FAC
That Are�OBL, FACW, or FAC 7 (A)
2
Total Number of Dominant
3
Species Across All Strata 8 (B)
4
Percent of Dominant, Species
5
That Are OBL, FACW„ or FAC 88 (A/B)
6
-
Prevalence Index worksheet-
7
Total % Cover of Multiply by
8
30, = TotahCover
OBL species x 1 =
50% of total cover
20% of total cover
FACW species x 2-
Saplma /Shrub Stratum (Plot size 30x30 )
FAC species x3=
1 L-igwdambar styraciflua
10 X FAC
FACU species x4=
2' Acer rubrum
5 FAC
'IJPL species x,5 =
3 'Ligustrum sinense
10 X FACU
Column Totals (A) (B) -
Prevalence Index = B/A =
4 Acer negundo 15 X FAC
5,
Hydrophytic Vegetation Indicators
6
1 -Rapid Test for Hydrophytic'Vegetabon
7
❑✓ 2 - Dominance Test is >50%
8
II 3 - Prevalence Index, is 53 0'
10 Problematic ,Hydrophytic,Vegetathon' (Explain)
40 = Total'Cover
50% of total cover
20% of total cover
Herb Stratum (Plot size 3000
)
'Indicators of hydnc sod and'wetiand hydrology must
1 Boehmena cylindnca
5 FACW
be present, unless disturbed.or problematic
2 Microstegeumtivi mini um
50 X FAC
5efinitions of Four Vegetation Strata:
3 Juncas'effusus 10 FACW
Tree -Woody plants, excluding vines, 3 in (7 6 cm) or
4 Toxicodendron radicans
20 FAC
more in diameter at breast'height (DBH), regardless of
5
`height
SaphnglShrub -Woody plants, excluding vines, less
than 3 m DBH and greater than,3 28 ft (1`m) tall
6 --
7
8
Herb - All herbaceous (non- woody) plants, regardless
g
of size, and woody,plants less than 3 281ft tall
Woody vine = All woody vines greater thar13 28 ft in
10
11
height
12
85, = Total Cover
50% of total cover
20% of total cover
Woody Vine Stratum (Plot size
30x30 )
1 Toxicodendron radicans
5 X FAC
2 ,Lonicera'japonica 5 X FAC
3 Smilax rotundifolia 5 X FAC
4
5
Hydrophytic
Vegetation
15 = Total Cover'
Present? Yes _X No
50% of total cover
20% of total cover
Remarks (If observed, list morphological adaptations below)
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2 0

'SOIL
Sampling Point- W'TL M1
Profile Description (Describe to the depth needed to document the Indicator or confirm the absence,of indicators.)
Depth Matrix Redox Features
(inches) ColoNmoist) % _ Color (moist) % Type Loc Texture Remarks
0 -9 10YR 6/1 100
9 -14+ 10YR 5/3 80 5Y 7/4 20
J
1
'Type C= Concentration, D= Depletion, RM= Reduced Matrix, MS= Masked Sand Grains 2Location- PL =Pore Lmmq, M= Matroc
Hydric SoWIndicators: (Applicable to;all L"RRs, unless otherwise noted')
Indicator§ for Problematic Hydric Sods':
F] Histosol (A1)
HHistic Epipedon (A2)
n
H
Polyvalue Below Surface (S8) (LRR S, T, U)
Thin Dark Surface (S9) (LRR S, T, U)
❑
1 cm Muck, (A9) (LRR 0)
2 cm Muck (A10) (LRR S)
Black Histic (A3)
❑ Hydrogen Sulfide'(A4)
®Stratified Layers (A5)
❑
n
Loamy Mucky Mineral (F1) (LRR 0)
Loamy�Gieyed Matrix (F2)
Depleted'Matnx,(F3)
TI
u
_E1
Reduced Vertic (F18) (outside MLRA 150A,B)
Piedmont Floodplam Sods (F19) (LRR P, S, T)
Anomalous Bright Loamy Sods (F20),
Organic Bodies (A6) (LRR P, T, U)
❑5 cm Mucky Mineral (A7) (LRR P, T, U)
Muck Presence (A8) (LRR U)
❑ 1 cm Muck (A9) (LRR P, T)
111�JJ
❑
Redox Dark Surface (F6)
Depleted Dark Surfac:e,(F7)
Redox Depressions (F8)
Mari (F10) (LRR U)
(MLRA 153B)
❑ Red Parent Material (TF2)
ID Very'Shallow Dark Surface (TF12)
1:1 Other (Explain m,Reinarks)
❑ Depleted Below Dark Surface (At 1)
❑
Depleted�Ochnc (F11) (MLRA 151)
❑ Thick Dark Surface (Al2)
❑Coast Prairie Redox (A16) (MLRA 150A)
❑
Iron - Manganese Masses (F12) (LRR 0, P, T)
Umbnc Surface (F13) (LRR P, T, U)
'Indicators,of hydrophytic vegetation and
wetland hydrology must be present,
Sandy Mucky Mineral (S1) (LRR 0, S)
❑ Sandy Gleyed Matnx (S4)
❑
Delta Ochnc (F17) (MLRA 151)
Reduced`Vertic (F18) (MLRA 150A, 1508)
unless disturbed or problematic
❑Sandy Redox (S5)
Piedmont Floodplam Soils (F19) `(MLRA 149A)
Stripped Matrix (S6)
Anomalous Bright Loamy Sods (1720) (MLRA 149A,
153C, 153D)
❑ Dark Surface (S7) (LRR P, S, T, U)
Restrictive Laver (if observed)
Type
Depth,(inches)
Remarks
Hydric Soil Present? Yes X No
US Army,Corps of Engineers Atlantic and Gulf Coastal Plain Region— Version 2,0

WETLAND DETERMINATION DATA FORM - Atlantic and Gulf Coastal Plain Region
Project/Sae Falls Road Baptist Church City/County Rocky Mount/Nash Sampling Date 7 Nov 13
Applicant/Owner Falls Road Baptist Church State NC Sampling Point WTL M1
Investigator(s) Chris Hopper, Klemfelder Southeast Section, Township; Range Rocky Mount/Drake INC, USGS Quads
Landforn (hilislope, terrace, etc) headwater Local relief (concave, convex, none) concave Slope ( %) 2 -6
Subregion (LRR or MLRA) LRR'T Lat 36 001398 Long "77 829849 Datum NAD83
Sod Map Una Name Norfolk Wedowee complex NWI classification PF01
Are climatic /'hydrologic conditions on the site typical for,this time of year? Yes X No (If no, explain in Remarks)
Are Vegetation Sod 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.
Hydrophybc Vegetation Present? Yes X No Is,the Sampled Area
Hydnc Sod Present? Yes X_ No within°a Wetland? Yes X No
Wetland Hydrology Present? Yes X No
Remarks
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
❑ Surface Sod Cracks (B6)
❑ Sparsely Vegetated, Concave Surface (68) 1
❑ Drainage Patterns (1310)
❑ Moss Trim Lines (1316)
Dry- Season Water Table (C2)
Crayfish Burrows (C8) '
❑ Saturation Visible on Aerial Imagery (C9)
II' Geomorphic Position (D2)
Primary Indicators,(mmimum,of_one is required, check all that apply)
'❑
❑
❑
❑_
_
Q
Surface Water (Al) El Aquatic,Fauna (1313)
High Water Table (A2) 0 Marl Deposits`(B15) (LRR U)
Saturation (A3) 10 Hydrogen Sulfide Odor (C1)
Water Marks (61) 1R1 Oxidized Rhizospheres along Living Roots (C3)
Sediment Deposits (62) X17 Presence of,Reduced Iron (C4)
Drift,Deposas (133) LJ Recent Iron Reduction'm Tilled Sods (C6)
Algal Matsor Crust (134) ❑ Thin Muck Surface (C7)
Q
Iron Deposits (135)
Other (Explain in Remarks)
Shallow Aguitard (133)
❑
Inundation Visible on Aerial Imagery (137)
❑ FAC- Neutral Test (D5)
❑
Water - Stained Leaves (139)
❑ Sphagnum moss (D8) (LRR T, U)
Field observations-
Surface Water Presents Yes
No X Depth (inches)
Water Table Present? Yes
Saturation, Present? Yes
includes capillary fringe)
No X Depth (inches)
No X Depth (inches)
Wetland Hydrology Present? Yes X No
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available
Remarks
US Army,Corps of,Engmeers Atlantic,an& Gulf Coastal Plain Region —Version 2 0

VEGETATION (Four Strata) — Use scientific names of plants
Tree Stratum (Plot size 30x30
1 Liquidambarstyraciflua
2
•3
4
5
6
'7
8
Sampling Point WTL M1
Absolute Dominant Indicator Dominance Test worksheet:
% Cover Species? Status Number of Dominant Species
30 X FAC That Are OBL, FACW, or FAC 7 (A)
Total Number of Dominant
Species Across AIIIStrata 8 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC 88 (A/B)
30 = Total Cover
50% of total cover 20% of total cover
Sapling /Shrub Stratum (Plot'size 30x30 )
1 Liqwdambar styraciflua 10 X FAC
,2 Acer rubrum 5 `FAC
3 Ligustrum smense 10 X FACU
4 Acer negundo 15 X FAC
5
,6
7
8
50% of total cover
Herb,Stratum (Plot size 30x30 )
1 Boehmena cylmdnca
2 Microstegeum vimmium
3 Juncas effusus
4 Toxicodendron,radicans
5
6
7
8
9
f0
11
12
50 % of total�cover
Woody Vine Stratum (Plot size 30x30 )
1 Toxicodendron radicans
2 Lomcera japonica
3 Smilax rotundifolia
4
5
US Army Corps of Engineers
= Total Cover
20% of totabcover
Totah% Cover of
Multiplv'bv
OBL species
is 1 =
FACW species
x2=
FAC species
x 3 =
FACU- species
x 4 =
UPL,species
x,5 =
Column Totals,
(A) (B)
Prevalence Index =
B/A =
Hydrophytic Vegetation Indicators*
❑ 1 - Rapid Test for Hydrophytic Vegetation
R1 2 - Dominance Test is >50%
3 - Prevalence Index is 53.01
12 Problematic Hydrophytic Vegetation' (Explain)
'Indicators,of hydnc sod and wetland hydrology must
5 FACW be present, unless °disturbed' or problematic
50 X FAC Definitions of Four Vegetation Strata
10 FACW
20 FAC 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 3 in DBH and greater than 3 28 ft (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 wnes,greater than,3 28 ft,m'
height
85 Total Cover
20% of total cover
5 X FAC
5 X FAC
5 X FAC
15 = Total Cover
50% of total cover 20% of total cover _
morphological adaptations below)
Hydrophytic
Vegetation
Present? Yes X No
Atlantic and Gulf Coastal Plain Region — Version 2 0

SOIL
to the depth needed to document the indicator or
Sampling Point WTL M1
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Tvoe Loc Texture Remarks
0 -9 10YR 6/1 100
9 -14+ 10YR 5/3 80 5Y -7/4 20
'Type C= Concentration D= Depletion, RM= Reduced Matrix, MS= Masked Sand Grains `Location PL =Pore Lining, M= MatrLx
HydriwSoWindicators (Applicable to all LRRs,, unless otherwise noted') Indicators for Problematic Hydric Soils':
Histosol (Al)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
Organic, Bodies ,(A6) (LRR,P; T, U)
5 cm Mucky'Mmeral (A7) (LRR P, T, U)
Muck Presence (A8) (LRR U)
1 cm Muck (A9) (LRR P, T)
Depleted Below Dark Surface (A11)
Thick Dark< Surface (Al2)
Coast Prairie Redox (A16) (MLRA 150A)
Sandy Mucky Mineral (S1) (LRR O „S)
Sandy Gleyed Matrix (S4)
Sandy Redox (S5)
Stripped Matnx,(S6)
Dark Surfacei(S7) (LRR4P „S, T, U)
Type
Depth (inches)
Polyvalue Below Surface'(S8) (LRRS, T, U)
❑
1 cm Muck (A9) (LRR`O)
Thin Dark Surface (S9) (LRR'S, T, U)
2 cm Muck (A10) (LRR S)
Loamy Mucky Mineral (F1) (LRR O)
Reduced Vertic (F18) (outside MLRA 150A,B)
Loamy Gleyed Matrix (F2)
�--I
u
_E1
Piedmont Floodplain Sods (F19) (LRR P, S, T)
Depleted Matnx (F3)
Anomalous Bnght,Loamy Sods (F20)
Redox Dark Surface (F6)
(MLRA 153B)
Depleted Dark Surface (F7)
Parent Material ,,(TF2)
'El
Redox Depressions (F8)
u Very Shallow Dark Surface (TF12)
Very
Mart (1710) (LRR U)
1:1 Other (Explain in Remarks)
Depleted Ochric (F11) (MLRA1 51)
Iron - Manganese Masses (1712) (LRR 0, P,'T)
3Indicators of hydrophytic vegetation and
Umbric'Surface (F13) (LRR P, Too
wetland hydrologyimust be present,
Delta Ochnc (1717) (MLRA 151)
unless disturbed or problematic
Reduced Vertic (F18) (MLRA 150A, 150B)
Piedmont Floodplam Sods (F19) (MLRA 149A)
Anomalous Bright Loamy Sods (F20) (MLRA 149A, 153C, 153D)
Hydric Sod Present? Yes X No
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2 0

WETLAND DETERMINATION DATA'FORM - Atlantic and Gulf Coastal Plain Region
Project/Site Falls Road Baptist Church City /County Rocky Mount/Nash Sampling Date 7 Nov 13
Applicaht/Owner Falls�Road Baptist ^Church State NC Samplmg ^Point WTL M1
Investigator(s) Chris Hopper, Kleinfelder Southeast Section, Township, Range Rocky Wunt/Drake'NC, USGS Quads
Landfonn (hillslope, terrace, etc ) headwater Local relief (concave, convex, none)- concave Slope ( %) 2 -6_
Subregion (LRR or MLRA) LRR T Lat 36 001398 Long -77 829849 Datum NAD83
Soil,Map Unit Name Norfolk Wedowee complex NWI classification PF01
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks)
Are Vegetation Sod or Hydrology significantly disturbed? Are "Normal Circumstances" presents Yes X No,
Are Vegetation Sod 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 X No Is the Sampled,Area
Hydnc Sod Present? Yes x No Within a' Wetland? Yes X No
Wetland Hydrology Present? Yes x No
Remarks
HYDROLOGY
Wetland Hydrology Indicators
Secondary- Indicators (minimum,of two required)
❑ Surface,Soil Cracks (136)
❑ Sparsely Vegetated Concave Surface (138)
Primary Indicators (minimum of one is required, check all that aooly)
❑f
Surface Water (Al) El Aquatic Fauna (B13)
LJ
High Water TabW(A2)
Marl Deposits (B15) (LRR U)
❑ Drainage Patterns (1310)
❑
Saturation (A3)
1u-f
Hydrogen Sulfide Odor (Cl)
Moss'Tnm,Lines (616)
❑---III
Water Marks (B1)
1L�Jf
Oxidized'Rhizospheres along Living Roots (C3)
Dry- Season Water Table (C2)
III---
Sediment Deposits (132)
1IJf
Presence of Reduced Ir6n,(C4)
Crayfish Burrows (C8)
_
Drift Deposits (B3)
tL--Jf
LJ Recent Iron Reduction in Tilled Soils (C6)
❑ Saturation Visible on Aerial Imagery (C9)
a
Algal Mat or Crust,(B4)
❑ Thin.Muck Surface (C7<)
❑ Geomorphic, Position (D2)
Iron Deposits (B5)
1:1 Other (Explain in Remarks)
❑ Shallow Aqudard (D3)
Q
Inundation Visible on Aerial Imagery (B7)
❑ FAC- Neutral Test (D5)
❑
Water - Stained Leaves (B9)
❑ Sphagnum moss (D8) (LRR T, U)
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 ,X No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections) „if available
Remarks
US Army Corps of Engineers Atlantic and Gulf CoastaWlam Region — Version 2 0

VEGETATION (Four Strata) — Use scientific; names, of plants
Sampling Point WTL M1
50% of total cover
Herb Stratum (Plot size 30x30 )
1 Boehmena cylindnca
2 Microstegeum viminwm
3 Juncas,effusus
4 Toxicodendron radi cans
5
6
7
8
9
10
11
12
40 = Total Cover
Absolute
Dominant Indicator
Dominance,Test worksheet
Tree Stratum (Plot size 3000 )
1 L'iquidambar styraciflua
%'Cover
30
Species?
X
Status
FAC
Number of Dominant'Species
That Are OBL, FACW, or FAC 7
Total Number of Dominant
Species,Across'Ail Strata 8
(A)
(B)
2, -
-
3
4 —
5
20 FAC
more in diameter at,breast'height (DBH), regardless of
Percent
That reoOBL, FACW, or FAC 88
(A/B)
6
Prevalence Index,worksheet:
7
Total % Cover of Multiply by
8
OBL.species x 1_ _
30 =Total Cover
50% of total cover
Sapling /Shrub Stratum (Plot,size 30x30 )
1 Ligwdambar styraciflua
2 Acer rubrum
20% of total cover
10 X
5
FAC,
FAC
FACW species x2=
FAC species x 3 =
FACU species x4=
UPL species x 5 =
Column Totals (A)
(B)
3 ,Ligustrum sinense 10 X FACU
4 Acer negundo
15
X
'FAC
Prevalence Index = B/A =
5
Hydrophytic Vegetation Indicators:
6
a 1 - Rapid Test for Hydrophytic Vegetation
9✓ 2 - Dominance Testis >50%
7
8
❑ 3 Prevalence' Index is 53 0'
50% of total cover
Herb Stratum (Plot size 30x30 )
1 Boehmena cylindnca
2 Microstegeum viminwm
3 Juncas,effusus
4 Toxicodendron radi cans
5
6
7
8
9
10
11
12
40 = Total Cover
a Problematic Hydrophytic Vegetabon' (Explain)
_ 20% of total cover ,
'Indicators of hydnc sod and wetland hydrology must
5 FACW
be present, unless disturbed or problematic,
50 X FAC
Definitions of Four Vegetation Strata:
10 FACW
Tree — Woody plants, excluding vines, 3hn (7 6,cm) or
20 FAC
more in diameter at,breast'height (DBH), regardless of
height
Sapling /Shrub — Woody plants, excluding vines „less
than,3'in DBH and,greater than 3 28 ft (.L 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
85 = Total Cover
50% oftota_I cover 20% of total cover
Woody Vine Stratum (Plot size 30x30 )
1 Toxicodendron radicans 5
2 Lonicera japonica 5
3 Smilax rotundifolia 5
4
5
50% of total cover
Remarks (If observed, list
X FAC
X FAC
X FAC
Hydrophytic
= Total Cover Vegetation
20% of fotal cover Present? Yes X No
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2 0

SOIL
(Descnbe to the depth needed to document the indicator or confirm'the absence
Sampling Point , WT,L M 1
Depth Matrix _ Redox Features
(inches) Color (moist) % Color(moist) % Type' _ Loc Texture Remarks
0 -9 10YR 6/1 100
9 -14+ 10YR 5/3 80 5Y 7/4 20
'Type C= Concentration, D= Depletion, RM =Reduced, Matrix, MS= Masked Sa
Hydric Soil Indicators• (Applicable to all LRRs, unless otherwise noted)
U Histosol (Al)
Histic Epipedon (A2)
Black Histic,(A3)
❑ Hydrogen Sulfide (A4)
Stratified Layers (A5)
Organic Bodies (A6) (LRR P, T. U)
5 cm,Mucky Mineral (A7) (LRR Pj, U)
Muck Presence (A8) (LRR U)
❑ 1 cm Muck (A9) (LRR P, T)
❑ Depleted,Below Dark Surface (At 1)
❑ Thick Dark,Surface (Al2)
Coast P,rame,Redox (A16) (MLRA 150A)
Sandy Mucky Mineral (S1) (LRR O, S)
❑ Sandy Gleyed Matrix (S4)
Sandy Redox (S5)
Stnpped`Matnx (S6)
❑ Dark Surface (S7) (LRRiP,,S, T, U)
Restrictive Layer (if observed):
Type
Depth (inches)
`Location PL =Pore Lining, M =Matrix
Indicators for Problematic,Hydrrc Soils':
Polyvalue Below Surface (S8) (LRR S, T, U)
❑
1 cm Muck (A9) (LRR O)
Thin Dark Surface (S9) (LRR S, T, U)
2 cm Muck (A10) (LRR S)
Loamy Mucky Mineral (F1) (LRR O)
Reduced Vertic (F18) (outside,MLRA 150A,B)
Loamy Gleyed Matrix (172)
El
Piedmont Floodplam Sods (F19) (LRR P, S, T)
Depleted Matrix (F3)
_E1
Anomalous Bright Loamy Sods (F20)
Redox Dark Surface (F6)
(MLRA 1538)
❑
Depleted Dark Surface (F7)
Red Parent,Matenal (TF2)
Redox Depressions (F8)
❑ Very Shallow'Dark Surface (TF12)
Marl (1710) (LRR U)
Other (Explain in Remarks)
Depleted Ochnc (F11) (MLRA 151)
Iron - Manganese Masses (1712) (LRR O, P, T)
3Indicators of hydrophytic vegetation and
Umbnc Surface (F13),(LRR,P, T „U)
wetland, hydrology mustbe present,
Delta Ochnc (1717) (MLRA 151)
unless disturbed or problematic
Reduced Vertic (F18) (MLRA 150A, 150B)
Piedmont Floodplam Sods (F19) (MLRA 149A)
Anomalous,Bnght Loamy Sods (F20) (MLRA 149A „153C, 153D)
Hydric Soil Present? Yes X No
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2 0

WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region
Project/Site Falls Road Baptist Church City /County Rocky Mount/Nash Sampling Date ,Nov 13
Applicant/Owner Falls Road Baptist Church State NC Sampling Point WTL M1
Investigator(s) Chns Hopper, Kleinfelder Southeast Section, Township, Range Rocky MounUDPake INC, USGS Quads
Landfonn (hdlslope „terrace, etc,) headwater Local relief (concave, convex; none) concave Slope ( %) 2 -6
Subregion (LRR or MLRA) LRR'T Lat 36 001398 Long -77"829849 Datum :NAD83
Sod Map Unit Name Norfolk Wedowee complex NWI classification PF01
Are,dimafic / hydrologic conditions on the, site typical for this time of year? Yes X No (If no, explain in Remarks )
Are Vegetation , Sod or Hydrology ,significantly disturbed? Are "Normal Circumstances” present? Yes X No
Are Vegetation , Sod or Hydrology naturally problematic? (If needed, explain any answers in Remarks)
SUMMARY OF FINDINGS — Attach site,map showing sampling point locations, transercts, important features, etc.
Hydrophytic Vegetation Present? Yes X No
Is-the,Sampled Area
Hydnc Sod Present? Yes x No X
within�a Wetland? Yes No
Wetland Hydrology Present? Yes X No
Remarks
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
❑ Surface Sod Cracks (136)
❑ Sparsely Vegetated Concave Surface (138)
Pnmaiv Indicators (minimum of one is required, check,all that apply)
❑ Surface Water (Al) ❑-f Aquatic Fauna (6,13)
❑ High Water Table (A2)
1
----If Marl Deposits (1315) (LRR U)
❑ Drainage Patterns (810)
❑ Saturation (A3)
11
U Hydrogen Sulfide Odor (C1)
❑ Moss Trim Lines (616)
❑ Water Marks,(B1)
Oxidized Rhizospheres along Living Roots (C3)
Dry- Season Water Table (C2)
Sediment Deposits,(132)
1Qf
❑ Presence of,Reduced,lron (C4)
❑✓ Crayfish Burrows (C8)
Drift Deposits (133)
LI Recent Iron Reduction in Tilled Sods (C6)
❑ Saturation Visible on Aerial Imagery (C9)
❑ Algal Mat or Crust (B4)
❑ Thin Muck Surface (C7)
0 Geomorphic Position (D2)
❑ Iron Deposits (B5)
0 Other (Explain in Remarks)
❑ Shallow Aquitard (D3)
Q Inundation Visible,on Aerial Imagery,(B7)
FAC Neutral Test (D5)
❑ Water- Stained'Leaves (139)
❑ Sphagnum moss (D8j (LRR T, U)
Field Observations
Surface'WaterPresent? Yes
No X Depth (inches)
Water Table Present? Yes
No X Depth (inches)
Saturation Present? Yes
No X Depth (inches) -
Wetland' Hydrology Present? Yes X No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available
Remarks,
US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Vernon 2 0

'VEGETATION (Four Strata) — Use scientific names of plants
Tree Stratum i(Plot+size 30x30 ) % Cover Soecieo
1 Liqwdarribar styraciflua 30 X
2
3
4
5
6
7
8
Sampling Point WTL M1
Status Number of Dommant %Species
FAC That Are OBL, FACW, or FAC 7 (A)
30 = Total Cover
50% of'total cover 20% of total cover
Sapling /Shrub Stratum (Plot size 30x30 )
1 Liqwdambar styraciflua 10 X FAC
2 , Acer rubrum 5 FAC
3 'Ligustrum'smense 10 X FACU,
4 Acer negundo 15 X FAC
5
6
7,
8- —
40 = Total Cover
50% of total cover 20% of total cover _
Herb Stratum (Plot size 3000 )
1 Boehmena cylmdnca 5
2 Microstegeum vimirnum 50
3 Juncas effusus 10
4 Toxicodendron radicans' 20
5
6
7
8
,9
10
11
12
FACW
X FAC
FACW
FAC
85 = Total Cover
5OWof total cover 20% of total cover _
Woody Vine Stratum (Plot,s¢e 30x30 )
1 Toxicodendron radicans 5 X FAC
2 Lonicera japonica 5 X FAC
3 Smilax rotundifolia 5 X FAC
4 -
5 _
15 = Total`Cover
50% of total cover, 20% of total cover _
observed, list
Total Number of Dominant
Species Across All Strata 8 (B)
Percent of Dominant Species
That Are OBL, FACW, or FAC 88' (A/B)
Total % Cover of
Multioly by
OBLspecies
x 1 =
,FACW species
x 2-
FAC species
x3=
FACU species
x 4-
UPL species
x15 =
Column Totals
(A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
❑ 1 - Rapid Test for Hydrophytic Vegetation
21 2 - Dommance,Test is >50%
3 - Prevalence Index'is 53 0'
u Problematic Hydrophytic Vegetation' (Explain)
'Indicators of,hydnc soil and wetland hydrology must
'be present,,unless disturbed or problematic
Tree — Woody plants,.excludmg 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 DBH and greater than 3.28 ft,(1 m) tall
Herb — All herbaceous (non- woody) plants, regardless
of size, and woody plants less than 3 28 It tall
Woody vine — All woody vines, greater`than 3 28 1ft in
height
Hydrophytic
Vegetation
Present? Yes X No
US Army Corps otEngmeers Atlantic and Gulf Coastal Plain Region — Version'2 0

SOIL
Profile Description: (Describe to the depth needed`to document the indicator or confirm the absence
Depth Matrix
(inches) Color(moist) %
0 -9 10YR,6/1 100
9 -14+ 10YR 513 80
Sampling Point_ WTL M1
Redox Features
Color (moist) % Type' Fo c Texture _ Remarks
5Y 7/4 20
'Type C= Concentration, D= Depletion, RM= Reduced,Matnx, MS= Masked Sand Grains
Hydnc Sod Indicators: (Applicable'to all_LRRs, unless otherwise noted)
0 Histosol (Al)
Histic Epipedon (A2)
Black Histic (A3)
0 Hydrogen Sulfide (A4)
n Stratified, Layers (A5)
L�JI Organic Bodies,(A6) (LRR P, T, U)
5 cm Mucky Mineral (A7) (LRR P, T, U)
Muck Presence (A8) (LRR U)
❑ 1 cm, Muck (A9) (LRR P, T)
❑ Depleted Below Dark Surface (A11)
❑ Thick`Dark Surface (Al2)
Coast Praine Redox (A16) (MLRA 150A)
Sandy Mucky Mineral (S1) (LRR 0, S)
❑ Sandy Gleyed matrix (S4)
D Sandy Redox,(S5)
D
Stripped Matrix (S6)
❑ Dark Surface (S7) (LRR,P, S, T, U)
Restrictive Layer (if observed):
Type
Depth (inches)
2Location PL =Pore Lining, M= Matrix
Indicators for Problematic Hydnc Soils':
Polyvalue Below Surface (S8) (LRR,S, T, U)
❑
T cm Muck (A9) (LRR O)
Thin Dark Surface (S9) (LRR S; T, U)
2 cm Muck,(A10) (LRR S)
Loamy Mucky Mineral (F1) (LRR O)
Reduced Vencc (F18) (outside MLRA 150A,B)
Loamy Gleyed,Matnx,(F2)
T-I
U
Piedmont Floodplam Soils (F19) (LRR P, S, T)
Depleted Matrix (F3)
Anomalous Brnght'Loamy'Sods (F20)
Redoz'Dark Surface (F6)
(MLRA 153B)
❑ 'Red
Depleted Dark Surface (F7)
Parent,Matenal'(TF2)
'El
Redox Depressions (F8)
Very Shallow Dark Surface (TF12)
Marl (F10) (LRR'U)
]:] Other (Explain in Remarks)
Depleted Ochnc (F11) (MLRA 151)
Iron - Manganese Masses (F12) (LRR,O, P, T)
3Indicators of- hydrophytic vegetation and
Umbnc Surface (F13) (LRR P, T, U)
wetland hydrology;must be present,
Delta Ochnc (F17) (MLRA 151)
unless disturbed or problematic
Reduced Vertic (F18) (MLRA 150A, '150B)
Piedmont,Floodplam Soils (F19) (MLRA 149A)
Anomalous Bright Loamy Sods (F20) (MLRA 149A, 153C, 153D)
Hydnc Sod Present? Yes X No
US Army Corps'of Engineers Atlantic and Gulf Coastal Plam.Region — Version 2 0

Figures
1. Project Location Map
2. Project Overview Map
3. NWP 14 Impact Illustration
4. Sewer Line Buffer Impact Illustration

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Appendix A
Stream and Wetland Verification Documentation

PERMISSION TO ENTER PROPERTY
The undersigned property owner, Falls Road Baptist Church, hereby grants permission to�the U.S.,Army
Corps of Engineers (ACE) to,enter the undersigned's`property located at:
3144 Benvenue,Road, Rocky;Mount, NC 27804
This permission is limited to inspecting and advising on aquatic resources potentially subject to
on 404; and reviewing •proposed'activities,adjacent to these
jurisdiction under Clean Water Act Secti
areas. The undersigned shall not be liab{e fo�'injury, damage, or loss on the property,sufferedlby ACE,
its agents, or employees not caused by negligence or intentional acts of th&undersigned's agentssor
employees.
Signature of Undersigned (Property
'Printed�Name of Property Owner
2 - /2 -/,?
Date

NC®ENR
North Carolina Department of "Enviro6ment and Natural Resources
,Division of Water'Resources
Pat McCrory Thomas A Reeder John E Skvarla, III
Governor Director Secretary
Date Received
k' DVVQU's "e Only }Project' # =` - °`= r• _
Stream Origin /Buffer Applicability Determination
Required Information
1 Owner Information (corporation /individual who is legally responsible for the property'and its, compliance)
1a Name(s),on Recorded Deed
Falls Road Baptist Church
1 b Responsible Parry (for LLC)
3500 Gateway Centre Blvd, Morrisville NC 27560
1 c, Mailing Address
722 Falls Road,, Rocky Mount NC 27804
1'd Telephone °,Number
I
I le Email Address
5a Name of project
2 Location of Project,Site = please, include the county, nearest named town and highway number
Benvenue Road (LAT 35 998047 LON. 77 833226) Property`forms the northern comer of the intersection of Benvenue Road
'and Thomas A Betts Parkway
3 Has anyone from,DWQ visited the sites
N
Staff Name
NA
Date of Visits
NA
Additional Requested Information
4 Agent/Consultant Information (if applicable)
4a Name, Company
Christopher Hopper, Kleinfelder Southeast
4b Mailing address
3500 Gateway Centre Blvd, Morrisville NC 27560
4c Telephone no
919 755 5011 x103
4d Email address
I chopperCcDkleinfelder com
5 Project and Site Information
5a Name of project
Falls Road Baptist Church
'5b County
Nash
5c Nearest Named Stream
Hom. Beam Swamp (DWR 28 -724)
5d' River_B_asin
Tar-Pamlico,
5e Provide'a`bnef description of ithis project,(attach safe "plan if available)
Please attach a map of the site'!ndicating project boundaries on the USGS 1:24, 00,Topo and /or NRCS Sod Survey.
If you are unable,to locate either of these maps, please contact'the Re dional Office`for assistance.
;DWQ "Use_Only Is�this stream call fo�'the purposeaof 'r' r buffed mitigatio'ri ' t ' nutnen't offs'dfc�edit
Please return form to: Sara Krnes
1628 Mad Service Center Note Submittals on Friday after 12 00 pm will be
Raleigh, NC 27699 -1628 stamped as received on the next business
Fax [phone] day
Email sara krnes(cDncdenr gov
Please contact the Raleigh Regional Office at (919) 791 -4200 if'you have.any'questions
For DWR Staff Emad following documents to applicant:
Riparian,Buffer Authonzation & Help Document = PCN & PCN Checklist
0 Session Law 2012 -200 = Mmor/Major Variance

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•li Figure 1. USGS Maps, Drake NC and Rocky Mount NC
Falls Road Baptist Church, Rocky Mount (Nash County)
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Appendix C
Construction Plans for Falls Road Baptist Church Sewer Extension

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