20141074 Ver 1_Application_20141009

PAT McCRORY
GOVERNOR
US Army Corps of Engineers
Raleigh Regulatory Field Office
Attn: Mr. Dave Bailey
3331 Heritage Trade Dr., Ste. 105
Wake Forest, NC 27587
.1 . .
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
October 9, 2014
o � @'qF4
b�
OCT _ D
9 114
r�N P�RTATIONpERSPO6ROFs
SING UNlr
ANOTBONY J. TATA
SECRETARY
NC Division of Water Resources
Winston -Salem Regional Office
Attn: Mr. Dave Wanucha
585 Waughtown St.
Winston - Salem, NC 27107
Attention: Mr. Dave Bailey and Mr. Dave Wanucha
?-0 1 41 074
Subject: Notification for the replacement of Bridge 9245 over Beaver Creek on SR 3088
(Thacker Dairy Road) in Guilford County. WBS # 45353.1.27
Dear Ms. Homewood,
The North Carolina Department of Transportation is scheduled to replace Bridge #245 with a new bridge
at the same location. I have included the Attachments G & L with a project description and a set of the
project plans. A stormwater management plan is also attached. Please review this project for compliance
by your Division.
We plan to begin construction as soon as possible. If further information is required, please contact Jerry
Parker at (336) 256 -2063. Your early review and consideration will be appreciated.
Sincerely,
J.M. Mills, P.E.
Division Engineer, Division 7
Enclosures
cc: Tim Powers, NCDOT
Barry Harrington, Roadside Environmental Field Operations Engineer, NCDOT
Jeremy Warren, NCDOT
Bobby Norris, District 2 Engineer, NCDOT
File Copy '
P. O. Box 14996, GREENSBORO, NC 27415 -4996
PHONE [phone] FAx [phone]

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Tom Reeder John Skvarla, III
Governor Director Secretary
Attachment L: Low Impact Bridge Replacement Process
Low Impact Bridge Project No.: B -NIA County Guilford
Bridge No.245 over Beaver Creek WBS Element Number 45353.1.27
This project is subject to the Low Impact Bridge Process as agreed to on October 6,
2009. This project meets the documentation requirements and approval procedures
under NEPA, as defined by FHWA, for Low Impact Bridge Replacements. This project
meets the standards of NCDOT's Minimum Criteria Rules.
Date: October 9, 2014
Applicant Name: NCDOT
Applicant Address: 1584 Yanceyyille Street
Greensboro, NC 27415
Primary Contact for Project: Jerry A. Parker
Phone No.: 336 -256 -2063
Is this an after - the -fact application: Yes X No
River Basin: Cape Fear /Jordan Lake Watershed
Stream Classification: 16-19-3-4: WS-IV; NSW: 03 -06 -03
Regulatory Authorization Options for this Activity
Federal: IJSACE Nationwide General Permit 3 -- Maintenance
State: General Water Quality Certification #3687 and /or Buffer Authorization
Local: None
Project Description — The project consists of replacing Bridge #245 over Beaver Creek on SR
3088 (Thacker Dairy Road) and improving roadway approaches. The existing 35' L X 26' W
single -span bridge with timber deck on I -beams supported by timber -caps on piles and timber
bulkheads is structurally deficient and will be replaced with a new 70'. L X 28'W, single span
cored slab bridge at the same location. An off -site detour will be utilized during construction.
The project proposes to temporarily impact less than 0.01 acres of wetland with the installation
of an outlet pipe crossing for the stormwater discharge. The project also proposes to 38 linear
feet of permanent stream impact which is restricted to just the channel banks under the bridge
for the purposes of bank stabilization (i.e. no rip rap in the thalweg of the channel). The project
drainage system also consists of grated inlets and pipe outfalls that drain to existing roadside
ditches and swales or dissipator pads that outlet at non erosive velocities prior to the riparian
Transportation Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699 -1650
Location: 512 N Salisbury St., Raleigh, North Carolina
Phone: [phone] FAX: 919 - 733 -1290
Internet: http: /lportal.ncdenr.org /weblwq
An Equal Opportunity 4 Affirmative Action Employer
e
NhCarolina
Nahmallp,

buffer: Proposed Riparian Buffer impacts include 779 square feet in Zone 1 and 123 square
feet in Zone 2 to accommodate the wider span bridge and the necessary fill slopes. It should be
noted that there is a buffered stream channel that parallels the existing roadway. The project
proposes no impacts to this adjacent channel or its associated riparian area. A review was
conducted for the presence of Bald Eagle and small whorled pogonia, the only federally listed
protected species for Guilford County. An assessment within the review area showed no habitat
and review of NCNHP mapping showed no known occurrences of either species.
Signature:
Title: ,t�.•�a. %

-Attachment G: Low/Minimal Impact
Bridge Project Data Sheet
I
ITIP
NO
BD-51072
2
IWBS
Element No.
45353.1,27
3
!County
Guilford
4
1
Br dge Number
245
5
Descri ption
Bridge No. 245 over Alamance Creek on SR 3088 (Thacker Dairy Road)
6
Stream
Basin
Classification
SIN
Cape Fear
WS-1V: NSW
16-19-3-4
7
8
Size
10
SA: 10-12 ft. wide, 1-2 ft. deep; SB: 2-4 ft. wide, 0.5-1.0 ft. deep
11
Existing Structure
Type
Size--
Timber Deck on kBeams
12
13
Single Sp an Bridge I @35'6"
31.58
Suff. Rating
14
Pro "-sed Structure
Typj�
Single Span 24" PCCS
I @ 70'w/ 4' Deep Caps
16
Size
16
Stream
NCDWQ Impacts (LF)
ft. permanent
38 ft. permanent
17
18
Wetlands
USACE Impacts (AC
0.01 acre temporary
19
I Non 404 Impacts (AC
None
20
1 CAMA Impacts SF
N/A
21
NC DWQ Buffers Impacts (SF)
902 sq. ft.
22
Buffer Appli aton Required (YIN)
Yes
23
State Stormwater Permit Required (YIN)
No
24
T&E
Habitat
Present
None Present
None Present
No Effect
25
26
_��Rti�tes
Bio Conclusion
27
Moratorium
Type
None
-281
Dates
None
29
Trout Waters
i NativelHatchery
No
30
Trout S ecies Present—
No
—
31
ITrout Coq4itionsJY
-
32
IWRC Reviewer
- ---------
N/A
33
CAMAJAEcs
No
34
Essential Fish
l Habitat
None Present
35
Nay.
Opening
No
36
USCG
Permit
No
37
Historic
Pro perties
No
38
Archaeological
Resources
No
39
Tribal
Lands
No
40
4(f)
Resources
No
411
6(f) [LWCF]
Resources
No
42
Wild and
Scenic River
No
43
Federal
11-ands
No
44
TVA
Area
No
45
FEMAlBuyout
No
46
FEMA11
Flood Study
Yes (MOA Coordination)
47
USTs
Haz Mats
No
481
Relocatees
None
9
Location
LAT - ---- -
LONG
........ .. 36.01956
79.68689
51
r49
1
5 1
Project Comments
Cape Fear River Basin drains to Jordan Lake, so Jordan Lake Watershed buffer
rules apply.
Completed by:
11
Lead Engineer
Date:
Date:1
Divis n Environmental OfFicer
-- - - - - - - - - ] -I-
-- -- -- - -- -

FIGURES

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SITE LOCATION
0 1,000 2,000 4,000 Project No. BD 51072 FIGURE
Feet Bridge No. 245 over Beaver Creek
on SR 3088
1 inch = 2,000 feet Guilford County, NC
. Source: Sing Maps Aenal, Microsoft, copynght 2011

-1 toll

Bridge No. 245 on SR 3088 (Thacker Dairy Road) (TIP No. BD- 51072)
Looking east across bridge.
Upstream profile, looking north.

Bridge No. 245 on SR 3088 (Thacker Dairy Road) (TIP No. BD- 57072)
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Downstream view, looking north.
Upstream view, looking south.

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Project Tracking No. (Infernal tire)
13 -07 -0001
.r
HISTORIC ARCHICTECTURE AND LANDSCAPES
NO SURVEY REQUIRED FORM
This form only pertains to Historic Architecture and landscapes for this project. It
is not valid for Archaeological Resources. You must consult separately with the
Archaeology Group.
PROJECT INFORMATION
Project No:
BD -5107Z
County:
Guilford
WBS No.:
45353.1.27
Document
T e:
Fed. Aid No:
BRZ- 3088(1)
Funding:
State Z Federal
Federal
Z Yes No
Permit
Permit(s):
Ty e(s):
Proiect Description:
Replace Bridge No. 245 over Alamance Creek on SR 3088 (Thacker Dairy Road) in Guilford County.
Project length is approximately 0. 120 miles. The existing right -of -way is 60 feet and the proposed right -
of -way is 100 feet. There will be an off -site detour route of 4.7 miles. The project length and proposed
right -of -way are exaggerated at this time.
SUMMARY OF HISTORIC ARCHICTECTURE AND LANDSCAPES REVIEW
Description of review activities, results, and conclusions:
Review of HPO quad maps, HPOweb GIS mapping, historic designations roster, and indexes was
conducted on 7/11/13. Based on this review, there are no existing NR, SL, LD, DE, or SS properties in
the Area of Potential Effects (APE). Built in 1958, Bridge No. 245 is not eligible for listing to the
National Register of Historic Places (NRHP) according to the NCDOT Historic Bridge Inventory.
Guilford County GIS snapping and property records show one property over the age of fifty years old, a
ca. 1953 residence, within the project APE. However, the house does not appear to have the architectural
or historical significance needed to merit consideration for eligibility to the NRHP, further confirmed by
Google Street View imagery. The APE lies within the vicinity of the McLeansville community and
consists of mostly wooded areas dotted with patches of cleared farmland and residences along the
roadways. Thus, a survey is not required for this project.
Why the available information provides a reliable basis for reasonably predicting that there
are ito unidentified significant historic architectural or landscape resources in the project
area:
HPO quad maps, HPOweb GIS mapping, Google Street View, Google maps and Guilford County
property records are considered valid tools for the purposes of determining the likelihood of historic
resources being present. A survey is not required for this project.
Ilistoric Archilectare and Landscapes NO SURVF_Y RFQUIRED form for Aflaor Trmuportadon Projects as Qnalljled in the 1007 Progranuaalk Agreement.
Page 1 of 3

SUPPORT DOCUMENTATION
®Map(s) ❑Previous Survey Info. ❑Photos [—]Correspondence ❑Design Plans
FINDING BY NCDOT ARCHITECTURAL HISTORIAN
Historic Architecture and Landscapes -- NO SURVEY REQUIRED
NCDOT Atchitectural Historian Date
Historic Architecture and Landscapes NO SURYFY RFQUIRFD Jorm Jor bfinor 7rmtsportation Projects as Qualified in the ?007 Programmatic Agreement.
Page 2 of 3

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LUM County Home M= Tax Dept Home Tax Bills Record Card Tax Rates Search Results New Search Property search
Guilford County Real Property Data
Building Summary
Data last updated on: 7/11/2013
Ownership current as of: 7/10/2013
Parcel Number 0116516 PIN x 7892 66 8996
Location Address Property Description
5001 THACKER DAIRY RD Lot # 1 -4 BC PB 16 -17 AIRVIEW ACRES
i v:. ngc ' Improvements Land ale I photos + Tax Bill ' Mai
Building Location Address
Main and Addition
Building Description
Type
Card 1 of 1
/Aluminum or vinyl /CONTFOOT
5001 THACKER DAIRY RD
Porch, Open Fin
SFR
Attic, Unfinished
0
Basement, Unfinished
Bldg Type
SFRCONST
Year Built 1953 Effective Year
1966
Base Bldg Value
Ali
Units
1
Additions 3 Remodeled
Grade
C
Total Living Area
1710
Cond */6
I
Style
Ranch w /basement
One Fireplace (1)
Market Adj.
Foundation
CONTFOOT
Interior Adj.
Market Adj
Exterior
Aluminum or vinyl
Accrued
Const Type
Percentage Complete
Heating
Heat pump
Current Card Value
$;
Air Cond
CENTRAL
Other Features
All Other Cards
Baths
FULL:1 HALF: 0
Assessed Land Value
;:
Bedrooms
4
Assessed Total Value
$!
Building Sketch
ry
Main and Addition
Story
Type
15
/Aluminum or vinyl /CONTFOOT
0
Porch, Open Fin
0
Attic, Unfinished
0
Basement, Unfinished
Building Sketch
ry
Code
Area Inc
1710
FOPO
72
UATO
474
UBMO
792
F -7-1
(Click sketch for bigger Image)
Photograph
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Per North Carolina General Statute 105- 285 -287 (d), all real property In North Carolina is subject to listing and valuation annually as It exists on January 1. Real Property assessments are ba
market values as of the date of the last countywide reappraisal in 2012.
Prints best In landscape mode
Thursday, July 11, 2013
tabneb.co.g uilford.nc.us/camapublicaccess/Building D etai I s. aspn7 REID= 0116516 &YearFor= 20MBldg CardN um=1 1/1

Project Tracking No.:
13 -07 -0001
ooh¢... NO ARCHAEOLOGICAL SURVEY REQUIRED FORM
This form only pertains to ARCHAEOLOGICAL RESOURCES for this project. It is not 'C
' o valid for Historic Architecture and Landscapes. You must consult separately with the ;-
°* Historic Architecture and Landscapes Group. Q
PROJECT INFORMATION
Project No: BD -5107Z
WBS No: 45353.1.27
F.A. No: BRZ- 3088(1)
Federal Permit Required?
County: Guilford
Document: Not Listed
Funding: ® State ® Federal
❑ Yes ❑ No Permit Type: To be determined
Project Description: The NCDOT (Division 7) proposes to replace Bridge No. 245 on Thacker Dairy
Road (SR 3088) over Beaver Creek in Guilford County. Bridge No. 245 was built in 1958 and is
considered to be structurally deficient. There may be minor ditch impacts. An off -site detour is to be
used during construction. The proposed project measures approximately 633 feet (0. 12 mile) long by a
proposed ROW width of 100 feet. Based on these measurements, the Area of Potential Effects (APE)
measures approximately 63,300 square feet or about 1.45 acres, inclusive of the existing roadway and
structure.
SUMMARY OF CULTURAL RESOURCES REVIEW
Brief description of review activities, results of review, and conclusions:
A map review and site file search was conducted at the Office of State Archaeology (OSA) on Thursday,
July 11, 2013. An archaeological survey at this particular bridge location has never been conducted, and
no archaeological sites have been recorded within one -half (1/2) mile of the proposed project. Digital
copies of HPO's maps (McLeansville Quadrangle) as well as the HPOWEB GIS Service
(http: / /gis.ncdcr.gov/hpoweb /) were last reviewed on Friday, July 12, 2013. There are no known historic
architectural resources located within the project area that may have intact archaeological deposits within
the footprint of the proposed project. In addition, topographic maps, historic maps (NCMaps website),
USDA soil survey maps, and aerial photographs were utilized and inspected to gauge environmental
factors that may have contributed to historic or prehistoric settlement within the project limits, and to
assess the level of modern, slope, agricultural, hydrological, and other erosive -type disturbances within
and surrounding the archaeological APE.
Brief Explanation of why the available information provides a reliable basis for reasonably predicting
that there are no unidentified historic properties in the APE:
Both Federal and State funds may be used for project, which may or may not require a Federal permit and
permanent or temporary easements. Existing ROW appears to measure approximately 60 feet wide.
Therefore, there may be impacts up to 20 feet beyond the existing ROW along the project corridor. From
an environmental perspective, the APE consists of the steeply rolling and undulating terrain of the North
Carolina Piedmont, and is composed of Chewacla sandy loam (Ch) and Enon fine sandy loam, 10 -15%
slopes (EnD). Aside from the presence of relatively steep soil conditions to the north and south of the
project area, the APE primarily consists of soils that are poorly drained and subjected to severe flooding.
Thus, the current soil conditions and topography to either side of Beaver Creek would not be suitable
factors for containing intact archaeological deposits. Secondary road improvements for Tom Road (SR
"No ARCHAEOLOGY SURVEY RE& 11RED" form for Minor Transportation Projects as Quoli fted in the 2007 Programmatic Agreement.
1 of 2

Project Tracking No.:
13 -07 -0001
3080), which is located at the northern terminus of the APE, were reviewed and subsequently cleared by
the Office of State Archaeology, stating low probability for the project area (ER 03- 2907). Of note is a
nearby alternative corridor surveyed as part of the proposed I -85 Bypass of Greensboro (1- 2402); as part
of that survey (Hargrove 1991), only an isolated felsic thinning flake was recovered in the vicinity of
Thacker Dairy Road (SR 3088). Hargrove (1991:26) mentions that "plowing and soil erosion are the
major sources of disturbance. Erosion has been severe, and red clay subsoil has been exposed on the
surface throughout the vicinity of the site." Overall, the project corridor is unlikely to contain significant
cultural, archaeological, or historical resources. Based on the information above, there should be no
archaeological survey required for this project. If design plans change, then additional consultation
regarding archaeology will be required. At this time, no further archaeological work is recommended. If
archaeological materials are uncovered during project activities, then such resources will be dealt with
according to the procedures set forth for "unanticipated discoveries," to include notification of NCDOT's
Archaeology Group.
SUPPORT DOCUMENTATION
See attached: ® Map(s) ® Previous Survey Info
❑ Photocopy of County Survey Notes
FINDING BY NCDOT ARCHAEOLOGIST
NO ARCHAEOLOGY SURVEY REQUIRED
❑ Photos ❑Correspondence
Other:
Figure 1: McLeansville, NC (USGS 1952 [PR1968]).
"No ARCHAEOLOGY SURVEY REQUIRED " form for Minor Transportation Projects as Qualified in the 2007 Programmatic Agreement.
2 of 2

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0,- ARCADIS
Infrastructure, environment, buildings
Mr. David E. Bailey
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Subject:
Revised request for a Jurisdictional Determination of Waters of the United States
within the project study area — TIP No. BD- 5107Z; Bridge No. 245 over Beaver Creek
on SR 3088 (Thacker Dairy Road), Guilford County, NC.
Dear Mr. Bailey:
Attached is the revised Jurisdictional Determination request for the stream and
wetland delineation in the vicinity Bridge No. 245 over Beaver Creek on SR 3088
(Thacker Dairy Road), Guilford County, NC for the North Carolina Department of
Transportation ( NCDOT). The revision reflects your discussions with Robert Lepsic
(ARCADIS) at the March 5, 2014 field meeting. Wetland WA was extended to follow
a shallow Swale at the base of the road embankment until it connected to stream SA.
This area had been excluded from the original delineation conducted in November
2013, due to lack of hydrologic indicators at the time of the original delineation. If
you have any questions or concerns, please contact me either by phone or by email.
Sincerely,
ARCADIS G &M of North Carolina, Inc.
Martha M. Register
Environmental Planner /Senior Biologist
Copies:
Jerry Parker, NCDOT
Tim Jordan, HMM
File
Imagine the result
ARCADIS G &M of North Carolina
801 Corporate Center Drive
Suite 300
Raleigh
North Carolina 27607
Tel [phone]
Fax [phone]
www.arcadis- us.com
TRANSPORTATION
Date:
April 1, 2014
Contact.
Martha register
Phone:
919.854.1282
Email:
[e-mail]
Our ref_
NC612002.B141
ARCADIS G &M of North Carolina, Inc.
NC Engineering License # C -1869
NC Surveying License # C -1869

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SITE LOCATION
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Feet Bridge No. 245 over Beaver Creek
on SR 3088
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APPROVED JURISDICTIONAL DETERMINATION FORM
U.S. Army Corps of Engineers
This form should be completed by following the instructions provided in Section IV of the JD Form Instructional Guidebook.
SECTION I: BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FILE NAME, AND NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION: NCDOT TIP No. BD- 5107Z, Bridge No. 245 over Beaver Creek
on SR 3088 (Thacker Dairy Road), Guilford County, NC. Two streams are located within the study area: SA (Beaver Creek) and SB (UT to
Beaver Creek). Stream SB includes a pond (PA) which is located at the northwestern corner of the study area. Stream SC (also a UT to
Beaver Creek, but not in the study area) drains a headwater wetland (WA), whish is located in the southwestern comer of the project area.
State: NC County/parish/borough: Guildford City: Greensboro
Center coordinates of site (lat/long in degree decimal format): Lat. 36.02° N, Long. - 79.687° E.
Universal Transverse Mercator:
Name of nearest waterbody: Beaver Creek
Name of nearest Traditional Navigable Water (TNW) into which the aquatic resource flows: Haw River
Name of watershed or Hydrologic Unit Code (HUC): Haw River HUC 03030003
®Check if map /diagram of review area and/or potential jurisdictional areas is/are available upon request.
Check if other sites (e.g., offsite mitigation sites, disposal sites, etc... ) are associated with this action and are recorded on a
different JD form.
D. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
® Office (Desk) Determination. Date:
® Field Determination. Date(s):
SECTION II: SUMMARY OF FINDINGS
A. RHA SECTION 10 DETERMINATION OF JURISDICTION.
There M "navigable waters of the U.S." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [Required]
® Waters subject to the ebb and flow of the tide.
® Waters are presently used, or have been used in the past, or may be susceptible for use to transport interstate or foreign commerce.
Explain:
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There 0 "waters of the U.S." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Required]
1. Waters of the U.S.
a. Indicate presence of waters of U.S. in review area (check all that apply):
TNWs, including territorial seas
Wetlands adjacent to TNWs
Relatively permanent waterS2 (RPWs) that flow directly or indirectly into TNWs
Non -RPWs that flow directly or indirectly into TNWs
Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to but not directly abutting RPWs that flow directly or indirectly into TNWs
Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs
Impoundments of jurisdictional waters
Isolated (interstate or intrastate) waters, including isolated wetlands
b. Identify (estimate) size of waters of the U.S. in the review area:
Non - wetland waters: 675 linear feet: 2 to 15 width (It) and/or acres.
Wetlands: 0.35 acres.
c. Limits (boundaries) of jurisdiction based on: "bftod by isBWK
Elevation of established OHWM (if known):
2. Non - regulated waters /wetlands (check if applicable):3
'Boxes checked below shall be supported by completing the appropriate sections in Section III below.
2 For purposes of this form, an RPW is defined as a tributary that is not a TNW and that typically flows year -round or has continuous flow at least "seasonally"
(e.g., typically 3 months).

Potentially jurisdictional waters and/or wetlands were assessed within the review area and determined to be not jurisdictional.
Explain:
' Supporting documentation is presented in Section III.F.

Tributary stream order, if known: Tributary SA is a 3`d order stream, and SB and SC are V order streams.
(b) General Tributary Characteristics (check all that apply):
Tributary is: ® Natural
❑ Artificial (man- made). Explain:
® Manipulated (man- altered). Explain: SB is impounded at the northwest corner of the study area.
Tributary properties with respect to top of bank (estimate):
Average width: SA - 10 -12 ft; SB and SC - 2 -4 feet
Average depth: SA- 1 -2 ft; SB and SC 0.5 to 1.0 feet
Average side slopes: IVertical (1:1 or less).
Primary tributary substrate composition (check all that apply):
® Silts ® Sands ❑ Concrete
❑ Cobbles ® Gravel ❑ Muck
❑ Bedrock ❑ Vegetation. Type /% cover:
❑ Other. Explain: r
Tributary condition /stability [e.g., highly eroding, sloughing banks]. Explain: SA is moderately stable with some eroding
banks. SB is relatively unstable. The channel is eroding a hillslope. The lower portion of the creek runs through a residential lawn
were it is becoming entrenched. SC banks are low and stable.
Presence of run/riffle /pool complexes. Explain: SA has minimal development of run /riffle /pool complexes. SB contains
mostly riffles /falls and pools. SC has good complexity with a meandering channel and well developed in- stream habitats.
Tributary geometry: Relatively straight
Tributary gradient (approximate average slope): 1 -2 %
(c) Flow:
Tributary provides for: Seasonal flo
Estimate average number of flow events in review area/year: 20 (or� g
Describe flow regime: All streams are perrenial streams. .
Other information on duration and volume:
Surface flow is: Discrete and confined. Characteristics: All streams flow in a well defined channel.
Subsurface flow: ,Unknown. Explain findings:
❑ Dye (or other) test performed:
Tributary has (check all that apply):
❑ Bed and banks
® OHWM6 (check all indicators that apply):
® clear, natural line impressed on the bank
❑
❑ changes in the character of soil
❑
❑ shelving
❑ vegetation matted down, bent, or absent
® leaf litter disturbed or washed away
❑
❑ sediment deposition
❑
❑ water staining
❑
❑ other (list):
❑ Discontinuous OHWM.7 Explain:
If factors other than the OHWM were used to determ
❑ High Tide Line indicated by: ❑
❑ oil or scum line along shore objects
❑ fine shell or debris deposits (foreshore)
❑ physical markings /characteristics
❑ tidal gauges
❑ other (list):
(iii) Chemical Characteristics:
the presence of litter and debris
destruction of terrestrial vegetation
the presence of wrack line
sediment sorting
scour
multiple observed or predicted flow events
abrupt change in plant community
ine lateral extent of CWA jurisdiction (check all that apply)
Mean High Water Mark indicated by:
❑ survey to available datum;
❑ physical markings;
❑ vegetation lines /changes in vegetation types.
6A natural or man -made discontinuity in the OHWM does not necessarily sever jurisdiction (e.g., where the stream temporarily flows underground, or where
the OHWM has been removed by development or agricultural practices). Where there is a break in the OHWM that is unrelated to the waterbody's flow
regime (e g , flow over a rock outcrop or through a culvert), the agencies will look for indicators of flow above and below the break.
'Ibid.

SECTION III: CWA ANALYSIS
A. TNWs AND WETLANDS ADJACENT TO TNWs
The agencies will assert jurisdiction over TNWs and wetlands adjacent to TNWs. If the aquatic resource is a TNW, complete
Section III.A.1 and Section III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sections III.A.1 and 2
and Section III.D.1.; otherwise, see Section III.B below.
1. TNW
Identify TNW:
Summarize rationale supporting determination:
2. Wetland adjacent to TNW
Summarize rationale supporting conclusion that wetland is "adjacent":
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNW) AND ITS ADJACENT WETLANDS (IF ANY):
This section summarizes information regarding characteristics of the tributary and its adjacent wetlands, if any, and it helps
determine whether or not the standards for jurisdiction established under Rapanos have been met.
The agencies will assert jurisdiction over non - navigable tributaries of TNWs where the tributaries are "relatively permanent
waters" (RPWs), i.e. tributaries that typically flow year -round or have continuous flow at least seasonally (e.g., typically 3
months). A wetland that directly abuts an RPW is also jurisdictional. If the aquatic resource is not a TNW, but has year -round
(perennial) flow, skip to Section III.D.2. If the aquatic resource is a wetland directly abutting a tributary with perennial flow,
skip to Section III.D.4.
A wetland that is adjacent to but that does not directly abut an RPW requires a significant nexus evaluation. Corps districts and
EPA regions will include in the record any available information that documents the existence of a significant nexus between a
relatively permanent tributary that is not perennial (and its adjacent wetlands if any) and a traditional navigable water, even
though a significant nexus finding is not required as a matter of law.
If the waterbody° is not an RPW, or a wetland directly abutting an RPW, a JD will require additional data to determine if the
waterbody has a significant nexus with a TNW. If the tributary has adjacent wetlands, the significant nexus evaluation must
consider the tributary in combination with all of its adjacent wetlands. This significant nexus evaluation that combines, for
analytical purposes, the tributary and all of its adjacent wetlands is used whether the review area identified in the JD request is
the tributary, or its adjacent wetlands, or both. If the JD covers a tributary with adjacent wetlands, complete Section III.B.1 for
the tributary, Section I11.B.2 for any onsite wetlands, and Section 111.6.3 for all wetlands adjacent to that tributary, both onsite
and offsite. The determination whether a significant nexus exists is determined in Section III.0 below.
1. Characteristics of non -TNWs that flow directly or indirectly into TNW
(i) General Area Conditions:
Watershed size: 4.0 square miles
Drainage area: 4.0 square miles
Average annual rainfall: 42.2 inches
Average annual snowfall: 7.5 inches
(ii) Physical Characteristics:
(a) Relationship with TNW:
❑ Tributary flows directly into TNW.
® Tributary flows through 2 tributaries before entering TNW.
Project waters are J-55-220- river miles from TNW.
Project waters are 1 (or less) river miles from RPW.
Project waters are 110 -15 aerial (straight) miles from TNW.
Project waters are tt (or less) aerial (straight) miles from RPW
Project waters cross or serve as state boundaries. Explain:
Identify flow route to TNW5: Tributary SB and SC flow directly into SA (Beaver Creek). Beaver Creek drains into the
Alamamce Creek aprox. 3.5 miles northeast of the project area. Alamance Creek drains directly into the Haw River.
' Note that the Instructional Guidebook contains additional information regarding swales, ditches, washes, and erosional features generally and in the and
West.
5 Flow route can be described by identifying, e.g., tributary a, which flows through the review area, to flow into tributary b, which then flows into TNW.

Characterize tributary (e.g., water color is clear, discolored, oily film; water quality; general watershed characteristics, etc.).
Explain: Water is cloudy. Streams have a broken forested riparian buffer except at the road crossing. No oily film or
odors were observed.
Identify specific pollutants, if known:

(iv) Biological Characteristics. Channel supports (check all that apply):
® Riparian corridor. Characteristics (type, average width): Riparian corrodor is generally forested but not continous. It is
broken by Thacker Dairy Road.
❑ Wetland fringe. Characteristics:
® Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish /spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
® Aquatic /wildlife diversity. Explain findings: Asiatic clam shells were observed Tracks from deer and racoons were
noted along stream banks.
2. Characteristics of wetlands adjacent to non -TNW that flow directly or indirectly into TNW
(i) Physical Characteristics:
(a) General Wetland Characteristics:
Properties:
Wetland size: 0.35 acres r
Wetland type. Explain: Bottomland hardwood forest community on a small stream.
Wetland quality. Explain: Good. Wetland is forested and part of a larger forested area. NCDWR rating is 45. .
Project wetlands cross or serve as state boundaries. Explain:
(b) General Flow Relationship with Non -TNW:
Flow is: Intermittent flow. Explain:
Surface flow is: Overland sheetflow,
Characteristics:
Subsurface flow: ;Unkno . Explain findings:
❑ Dye (or other) test performed:
(c) Wetland Adjacency Determination with Non -TNW:
® Directly abutting
❑ Not directly abutting
❑ Discrete wetland hydrologic connection. Explain:
❑ Ecological connection. Explain:
❑ Separated by berm /barrier. Explain:
(d) Proximity ( Relationshi2) to TNW
Project wetlands arejl5 -10 river miles from TNW.
Project waters are i10 -15 aerial (straight) miles from TNW.
Flow is from: Wetland to navigable
Estimate approximate location of wetland as within the 11 0 - 0 eary floodplain.
(ii) Chemical Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; water quality; general watershed
characteristics; etc.). Explain: Water did not apprear to be discolored or oily. There was no noticable odor.
Identify specific pollutants, if known:
(iii) Biological Characteristics. Wetland supports (check all that apply):
® Riparian buffer. Characteristics (type, average width): forested 100 ft.
® Vegetation type /percent cover. Explain:Bottomland hardwood at 60 % cover.
❑ Habitat for:
❑ Federally Listed species. Explain findings:
❑ Fish /spawn areas. Explain findings:
❑ Other environmentally - sensitive species. Explain findings:
® Aquatic /wildlife diversity. Explain findings: Tracks of racoons and deer were observed.
3. Characteristics of all wetlands adjacent to the tributary (if any)
All wetland(s) being considered in the cumulative analysis: L
Approximately ( 0.35 ) acres in total are being considered in the cumulative analysis.

For each wetland, specify the following:
Directly abuts? (Y/N) Size (in acres) Directly abuts? (YIN) Size (in acres)
WA Yes 0.35 acres
Summarize overall biological, chemical and physical functions being performed: Wetland provides for water storage
during heavy rain events. Inflitrating water is filter thru the wetland prior to discharge into stream SC. Wetland vegetation
provides organic input as a food source for aquatic invertebrates.
C. SIGNIFICANT NEXUS DETERMINATION
A significant nexus analysis will assess the flow characteristics and functions of the tributary itself and the functions performed
by any wetlands adjacent to the tributary to determine if they significantly affect the chemical, physical, and biological integrity
of a TNW. For each of the following situations, a significant nexus exists if the tributary, in combination with all of its adjacent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and /or biological integrity of a TNW.
Considerations when evaluating significant nexus include, but are not limited to the volume, duration, and frequency of the flow
of water in the tributary and its proximity to a TNW, and the functions performed by the tributary and all its adjacent
wetlands. It is not appropriate to determine significant nexus based solely on any specific threshold of distance (e.g. between a
tributary and its adjacent wetland or between a tributary and the TNW). Similarly, the fact an adjacent wetland lies within or
outside of a floodplain is not solely determinative of significant nexus.
Draw connections between the features documented and the effects on the TNW, as identified in the Rapanos Guidance and
discussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to carry pollutants or flood waters to
TNWs, or to reduce the amount of pollutants or flood waters reaching a TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), provide habitat and lifecycle support functions for fish and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TNW?
• Does the tributary, in combination with its adjacent wetlands (if any), have the capacity to transfer nutrients and organic carbon that
support downstream foodwebs?
• Does the tributary, in combination with its adjacent wetlands (if any), have other relationships to the physical, chemical, or
biological integrity of the TNW?
Note: the above list of considerations is not inclusive and other functions observed or known to occur should be documented
below:
1. Significant nexus findings for non -RPW that has no adjacent wetlands and flows directly or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, then go to Section III.D: .
2. Significant nexus findings for non -RPW and its adjacent wetlands, where the non -RPW flows directly or indirectly into
TNWs. Explain findings of presence or absence of significant nexus below, based on the tributary in combination with all of its
adjacent wetlands, then go to Section III.D:
3. Significant nexus findings for wetlands'adjacent to an RPW but that do not directly abut the RPW. Explain findings of
presence or absence of significant nexus below, based on the tributary in combination with all of its adjacent wetlands, then go to
Section III.D:
D. DETERMINATIONS OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLY):
TNWs and Adjacent Wetlands. Check all that apply and provide size estimates in review area:
❑ TNWs: linear feet width (ft), Or, acres.
❑ Wetlands adjacent to TNWs: acres.
2. RPWs that flow directly or indirectly into TNWs.
® Tributaries of TNWs where tributaries typically flow year -round are jurisdictional. Provide data and rationale indicating that
tributary is perennial: SA, SB and SC are perennial streams. They scored 40, 24 and 24, respectively, on the NCDWQ
stream identification form. .
❑ Tributaries of TNW where tributaries have continuous flow "seasonally' (e.g., typically three months each year) are
jurisdictional. Data supporting this conclusion is provided at Section 111.13. Provide rationale indicating that tributary flows
seasonally:

Provide estimates for jurisdictional waters in the review area (check all that apply):
® Tributary waters: 675 linear feet 2 -15 width (ft).
_❑ Other non - wetland waters: acres.
Identify type(s) of waters:
3. Non -RPWs8 that flow directly or indirectly into TNWs.
❑ Waterbody that is not a TNW or an RPW, but flows directly or indirectly into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conclusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non - wetland waters: ' acres.
Identify type(s) of waters:
4. Wetlands directly abutting an RPW that flow directly or indirectly into TNWs.
® Wetlands directly abut RPW and thus are jurisdictional as adjacent wetlands.
® Wetlands directly abutting an RPW where tributaries typically flow year- round. Provide data and rationale
indicating that tributary is perennial in Section III.D.2, above. Provide rationale indicating that wetland is
directly abutting an RPW: Surface connection was observed leading from WA to stream SC.
❑ Wetlands directly abutting an RPW where tributaries typically flow "seasonally." Provide data indicating that tributary is
seasonal in Section 111.13 and rationale in Section III.D.2, above. Provide rationale indicating that wetland is directly
abutting an RPW:
Provide acreage estimates forjurisdictional wetlands in the review area: 0.35 acres.
5. Wetlands adjacent to but not directly abutting an RPW that flow directly or indirectly into TNWs.
❑ Wetlands that do not directly abut an RPW, but when considered in combination with the tributary to which they are adjacent
and with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisidictional. Data supporting this
conclusion is provided at Section III.C.
Provide acreage estimates for jurisdictional wetlands in the review area: acres.
6. Wetlands adjacent to non -RPWs that flow directly or indirectly into TNWs.
❑ Wetlands adjacent to such waters, and have when considered in combination with the tributary to which they are adjacent and
with similarly situated adjacent wetlands, have a significant nexus with a TNW are jurisdictional. Data supporting this
conclusion is provided at Section III.C.
Provide estimates for jurisdictional wetlands in the review area: acres.
7. Impoundments of jurisdictional waters.9
As a general rule, the impoundment of a jurisdictional tributary remains jurisdictional.
® Demonstrate that impoundment was created from "waters of the U.S.," or
❑ Demonstrate that water meets the criteria for one of the categories presented above (1 -6), or
❑ Demonstrate that water is isolated with a nexus to commerce (see E below).
E. ISOLATED ]INTERSTATE OR INTRA- STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADATION OR DESTRUCTION OF WHICH COULD AFFECT INTERSTATE COMMERCE, INCLUDING ANY
SUCH WATERS (CHECK ALL THAT APPLY):10
❑ which are or could be used by interstate or foreign travelers for recreational or other purposes.
❑ from which fish or shellfish are or could be taken and sold in interstate or foreign commerce.
❑ which are or could be used for industrial purposes by industries in interstate commerce.
❑ Interstate isolated waters. Explain:
'See Footnote # 3.
9 To complete the analysis refer to the key in Section III D 6 of the Instructional Guidebook.
10 Prior to asserting or declining CWA jurisdiction based solely on this category, Corps Districts will elevate the action to Corps and EPA HQ for
review consistent with the process described in the Corps /EPA Memorandum Regarding CWA Act Jurisdiction Following Rapanos.

❑ Other factors. Explain:
Identify water body and summarize rationale supporting determination:
,Provide estimates for jurisdictional waters in the review area (check all that apply):
❑ Tributary waters: linear feet width (ft).
❑ Other non - wetland waters: acres.
Identify type(s) of waters:
❑ Wetlands: acres.
F. NON - JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLY):
❑ If potential wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corps of Engineers
Wetland Delineation Manual and /or appropriate Regional Supplements.
❑ Review area included isolated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the Jan 2001 Supreme Court decision in "SWANCC," the review area would have been regulated based solely on the
"Migratory Bird Rule" (MBR).
❑ Waters do not meet the "Significant Nexus" standard, where such a finding is required for jurisdiction. Explain:
❑ Other: (explain, if not covered above):
Provide acreage estimates for non - jurisdictional waters in the review area, where the sole potential basis of jurisdiction is the MBR
factors (i.e., presence of migratory birds, presence of endangered species, use of water for irrigated agriculture), using best professional
judgment (check all that apply):
❑ Non - wetland waters (i.e., rivers, streams): linear feet width (ft).
❑ Lakes /ponds: acres.
❑ Other non - wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
Provide acreage estimates for non jurisdictional waters in the review area that do not meet the "Significant Nexus" standard, where such
a finding is required for jurisdiction (check all that apply):
❑ Non - wetland waters (i.e., rivers, streams): linear feet, width (ft).
❑ Lakes /ponds: acres.
❑ Other non - wetland waters: acres. List type of aquatic resource:
❑ Wetlands: acres.
SECTION IV: DATA SOURCES.
A. SUPPORTING DATA. Data reviewed for JD (check all that apply - checked items shall be included in case file and, where checked
and requested, appropriately reference sources below):
® Maps, plans, plots or plat submitted by or on behalf of the applicant/consultant:
® 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 Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
® U.S. Geological Survey map(s). Cite scale & quad name: 24,000 McLeansville Quad.
® USDA Natural Resources Conservation Service Soil Survey. Citation:Web Soil Survey Accesses 11/2013.
❑ National wetlands inventory map(s). Cite name:
❑ State /Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100 -year Floodplain Elevation is: (National Geodectic Vertical Datum of 1929)
® Photographs: ® Aerial (Name & Date): Bing Aerial 2011.
or ® Other (Name & Date): Site photographs 11/19/2013.
❑ Previous determination(s). File no. and date of response letter:
❑ Applicable /supporting case law:
❑ Applicable /supporting scientific literature:
❑ Other information (please specify):
B. ADDITIONAL COMMENTS TO SUPPORT JD:

USACE AID# _ DWQ # Site A (indicate on attached map) ^�
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment: R'
�t
1. Applicant's name: - "N 2. Evaluator's name: ���r�"• �� �'^' �� i� —
3. Date of evaluation? 1 13 4. Time of evaluation:
5. Name of stream: �� 6. River basin Q.k vt^
:7.Approximate drainage area: '� =`'� - 8. Stream order:
Y
9. Length of reach evaluated: 'ta` K 10. County: 4vy"
11. Site coordinates (if kriown): prefer in decimal degrees. 12. Subdivision name (if any): / t 'J �°1
Latitude (ex. 34.872312): 'No. 0 a aLongitude (ex. - 77.55661I): - " y � q 6 1-
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo /GIS ' t'teS�) Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach identifying streeam(s) location): f
CU1� --'t : -< , ,� � ) -0 i` 0LA, 4'�, >� ��; :1 - ^� tt -0 i � l . C4i4- W 3a vs
s `��
14. Proposed channel work (if i
15. Recent Weather conditions:_
16. Site conditions at time of vi
40
`..I
17. Identify any special waterway classifications known: _Section 10 _Tidal Waters Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters P Nutrient Sensitive Waters ✓Water Supply Watershed .%V (I -IV)
18. Is there a pond or lake located upstream of the evaluation point? YE&_N4W1fyes, estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20. Does channel appear on USDA Soil Survey? NO
21. Estimated watershed land use: JJD % Residential _% Commercial _% Industrial W% Agricultural
r%17 % Forested ^% Cleared / Logged -____% Other
22. Bankfull width: 10' 1 �A 23. Bank height (ftom bed to top of bank):
24. Channel slope down center of stream' —Flat (0 to 2 %) ✓Gentle (2 to 4 %) _Moderate (4 to 10 %) ySteep ( >10 %)
25. Channel sinuosity: Straight V Occasional bends _Frequent meander Very sinuous ,Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Score (from reverse): Comments: Mkti«ftaQ p a�\t - f
. ...,14,+1 a.
111NM, % ' t ' - • ,, Date 1 II &D 1?►
Evaluators Signature + � �- ""
This channel evaluation form is 'intend to be used only as a guide to assist landowners and a vironmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change - version 06/03. To Comment, please call 919- 876 -8441 x 26.
;.ti

STREAM QUALITY ASSESSMENT WORKSHEET
Ij t
t# C
.ECt)R)�(�!<QN `1"f1.1AT�'(' �
�,
; 4 irDREi
Evidence cif past human alteration p l
l to _ 4 I
I 0 S i
i 0-5 3
3 C1nG
l i
i _
_Ripaicur, zone -� f
f1 -ti 'Ix U
j t
tt 7
> , . (
Evidence qt nutr'cerit`ar Zero.
__ _
_ -
-
,� -
U -
-
�i -
J�a P
-CntrencbmenCo," xloodplain access A - g, ,{ ©
©_ �,r
0-3
F," (
i4 R
Root depth and density on banks ��� �) -• ; _
_ • • U _ -- 4 0
0. 5 "
"
� `
15 I
Impact by agi iculture, livestoc4, or timber production I 0
0-5 0 - A-
A-6
,
Is Canopy coverage over streambed , T, U
U 075
� - at'• "'
¢¢ 1�
Prclxence oi'strearn'iityarteh_ratetis Ps:-r, 1�a$e a ) 0
0-4 0-5. 0
0-3-
-
_... _
__. N
* These characteristics are not assessed in coastal streams.
2

NC DWO Stream Identii
Date: 0 IR 1 3
Evaluator:
Total Points:
Sftarn Is at least intermittent' L1Q
if k 19 oramnial ift 30* _!!
1 i
i Form Version 4.11 -Cy1C
Project/Site: I Latitude: -
County: ' f Longitude: . Lots!
Stream Determination (circle one ) Other vNNt („ d,_ SVS ta"
Ephemeral Interrmltten rem i e.g. Quad Name:
A. Geornor holo (Subtotal = -�
Absent
Weak
Moderate
Strong
f o' Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thatweg
0
1
CP
3
3. In- channel structure: ex. riffle -pool, step -pool,
ripple-pool sequence
0
--
2
3
4. Particle size of stream substrate
0
0.5
2
3
5. Active/relict floodplain
0
1
22. Fish
3
6. Depositional bars or benches
0
1
2
3
7. Recent alluvial deposits
0
1
2
8. Headcuts
0
1
3
9, Grade control
0
0,5
1.5
1.5
10. Natural- valley
0
0.5
1
1.
11. Second or greater order channel
No = 0
` Yep 3
- artiffoar ditches are not rates; see aiscussions in manual - --
R_ Hvdroloav (Subtotal =? .5, )
12 Presence of Baseflow
0
1
2
13. Iron oxidizing bacteria
0
iy
2.
3
14. Leaf litter
1.5
1
0
0
15. Sediment on plants or debris
0
0.5
9
1.5
16. Organic debris lines or piles 1
0 1
0.5
�0
1.5
17. Soil -based evidence of-high water table? I
No'= 0
3
C- Bioloov (Subtotal = Y 1
18. Fibrous roots in streambed
2
1
0
19. Rooted upland plants in streambed
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
�0
1
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0.5
1
1.5
24. Amphibians '
0.5
1
1.5
25. Algae
0
0.5
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 13
her =
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
x
` k1,*•
Sketch:
f l
�arM

.'DW # �.y� �`_..._ .._. _ __... _ . _ ... __ _.• Site #�.'(ind Cate on attached mapr-'+ /��
SACS AID #._....._.... Q
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment: L
1. Applicant's name: �N C 7b"t -70,0 � 2. Evaluator's name: kbbvv ),A4ZC A 1 l
3. Date of evaluation: t11 T 4. Time of evaluation: \a`•
5. Name of stream:_ \ir -�X> id- gLL&& -' UL 6. River basin: 4C LW 12i VC/111-1
7. Approximate drainage area: U 5 ��� 8. Stream order: rr 1
9. Length of reach evaluated: SL Ur 10. County: l'3t u I k C/
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): e
Latitude (ex. 34.872312): -5 6. C! ci- Longitude (ex. - 77.556611): ` :7 G l
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo /GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and fla1ndmarks and attach map i�dentifying�sstr[eam(s) location):
A. 3r1 1 % t.Y�SCVrf[��!V~ G't rf',— ni..'li1n N11" V`'If7 VC tf k-
14. Proposed channel work (if any): VIC
15. Recent weather conditions:
16. Site conditions at time of v
17. Identify any special waterway classifications known: _Section 10 _Tidal Waters Essential Fisheries Habitat
_Trout Waters _ _Outstanding Resource Waters i!f<trient Sensitive Waters &^ater Supply Watershed Id (I -IV)
18. Is there a pond or lake located upstream,of the evaluation point? Yk NO If yes, estimate the water surface area: qe
19. Does channel appear on USGS quad map? ES�l NO 20. Does channel appear on USDA Soil Survey?( YrE NO
21. Estimated watershed land use: &` % % Residential _% Commercial % Industrial �% Agricultural
J,% Forested �% Cleared ! Logged -�Q-°%o Other ( 1rr,+Qe- •:Sluff 1
22. Bankfull width: a' 3 23. Bank height (from bed to top of bank): 1- o'! 1•b`
24. Channel slope down center of stream: _Flat (0 to 2 %) ✓Gentle (2 to 4 %) Moderate (4 to 10 %) —Steep ( >10 %)
25. Channel sinuosity: Straight ✓ccasional bends _Frequent meander _Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring bozo and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Evaluator's Signature A' 0- '~ Date 111 ab i, 3
This channel evaluation form is intended to used only as a guide to assist landowners and a viro mental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change - version 06/03. To Comment, please call 919- 876 -8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
These characteristics fire not assessed in coastal streams.
2
C)V.:
t
"41
T
-COP 'GJt
Z X
.6nistal
A D INT
fWment
RANGF,-
I ukiountain
Pretence of flow-, pei'gi�tcut pools in st6am
aw
0 ts)
2
4j EVidence ot'pad human alteration
.0-6
0
o "Z
Col.
RiE+ai"iratn zone
no huf r ria w0'
01,�u-nliguvus. wide buflu =L__2�RL_
-
4
4
Evidence ofautrient oil-ebemiWi dibchafges
61 , - I ►N
To
0-5
0-4.
xten;rv,-, dikharze:s -ma'. R4Lni-)
Goun&?ter dkharge,
wetlaad* TAO)i
D
-(j-
0- 4
.W
Presence of -djieeut floudolain
LV� 4
0-4
ine
ftd�mp]An = U',v�Wnsive-T loodpjaLn - ,�,o
Ali
(duqblyeii,7iu ichcd = 0'1'equenvflboding� nM, pwftts )
i"
O-4
0-1
-
I esence 6t 01 cent wetlands
0- 4,
1)
(110 'Wetlands, - OF (Sue a-fi t,w en t vvelt-dids- ;= mu;- vvm# I
0-5
0-4,
W
Sedimeat In put
0 4'
anent= iiiax poitU)
tj
-%ize & di tstt� of"hannel bed,&ubsttate,
ve - C
0-4
D-L
-7
(fuu;, �M geijou;i- 0.1, tatlic, dWetse �Izes -xnax poinu)
-k -0
Ij
7
r---videuce of channel inGWon or Widening
11 1
G. 5,
Wlsipble heti & Katir,.2 = ma,�,'pdints)
Presence of majoi bank failu as
0-5
(:seven- etof.ion = 0'. go'etogion, -iiable'banll,s ---'max poilit")
(:seven-
Root Jeptb a fid-denifty con banks
71,:.3;
0-4 •
0
no viJbIe routs � O"denseirocts'thiTiti,,4hout:�F mx-<jpjntS)
luipactb'y agflbcultui•e, livestock, 0111mbel, P1 OdUrtioD
0-5
0- 4,
0-5
art 6o7evideric•e, �- jrAx
Presence ufritflie-poWfipple -pool compleALS
0 -
0- 6
(Tin ! U(1'e'viippiql-01 pook = 0°'Qll-devel.upcd = max, o"hr,)
WNW 6wplexity
-ecojef 'd baIntav, �-
it, �,Vk-
`
0-6
0-16
_
��
flittle of no habitat ftfi n)aL points)
_ —�
-� _ _
0 -;.5
0-5
C;.uiopy'C-0'%ii4ge over stfeimbed
0-5
Clio
19 1
Substrate em. beddeduess
NA;;
10 - a
, .
0
(&--ply Fm bOdtJ -- 0,-, loose stf jetur" Irfi5i.)
20
Presence of stream invertebrates (sce ilF c,4)
U- 4
41
21
Presente of amphibians
0-4
0-1
0icormlOn i Ants)
n �,04e= Pr
Piesence of fish ' I .
no evidence - 01, cqironc,n, nuincronE types u max;p0ints)"
0-4
1 0 -A!
C>
0 -4
1
0-5
y
Evidence G;f "i dfi-ji Me
23 (nt) - t Tkw,-. p6in1s)-_
0 6 -5
evidence- TLjqnt,evfdewx
*O(Ant7q Passible
100 J
(100
.1r0 TAL SCORE (.also,enter rin first pvp-)
A4
These characteristics fire not assessed in coastal streams.
2
C)V.:
t
"41

u. -r -to
NC DWO Stream Identification Form Version 4.11 „r C It f CSG)
Date: ;. I 3
Proj 05 ' z
Latitude: :CJ
Evaluator: l_ t IS
County:
Longitude:_ `
Total Points:
Stream Deterrnina I (cl e)
Other
Stream is at least intermittent r
if219 or perennial if a 30• 9
Ephemeral Intermitten - eren ' I
e.g. Quad Name: MCA 2c'm
A. Geomorphology Subtotal = t L-) ,
Absent
Weak
Moderate
Strong
I" Continuity of channel bed and bank
0
1
3
3
2. Sinuosity of channel along thalweg
0
CD
2
3
3. In- channel structure: ex. rifil"ool, step -pool,
ripple-pool sequence
0
C
2
3
4. Particle size of stream substrate
0
05
2
3
5. Active/relict floodplain
0
1
" 1.
3
6. Depositional bars or benches
0
22. Fish
2
3
7. Recent alluvial deposits
0
fi
2
3
8. Headcuts
> "J>
1
2
3
R. Grade control
0
0.5
24. Amphibians '
1.5
10. Natural valley
0
0.5
1.5
11. Second or greater order channel
25. Algae
= Yes= 3
- artmciai dacnes are not mtea; see oiscussions in manual -
B- Hvdroloav (Subtotal = '15, 1
12. Presence of Baseflow
0
2
3
13. Iron oxidizing bacteria
0
1
.,
3
14. Leaf litter
1.5
1
; °0:
0
15. Sediment on plants or debri$
0
: ° 0.5';
1
1.5
Organic debris lines -or piles
0
.5
q 1�
1.5
-16.
17. Soil -based evidence of high water table?
o = . • =
Yes = 3
C_ Bioloov (Subtotal = 4k l
18..Fibrous roots in streambed
2
1
0
19. Rooted upland plants in streambed
2
1
0
20. Macrobenthos {note diversity and abundance)
1
2
3
21. Aquatic Mollusks
0
" 1.
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0.5
1
1.5
24. Amphibians '
Q'
0.5
1
1.5
25. Algae
0
0.5
CJ0
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL =1.5
- Othe_r = b'
.
`perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
t
Sketch:
'
f
1
;
•
^A
f �
�! �"
N
L,_A�
E
1!-14
A g; arts
CEc,nW..

'USACE A1D# DWQ # r_- Site # '(indicate on attached map)
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment: r
1. Applicant's name: 'VC'1�9tT ' VI +U 1 2. Evaluator's name:.-- ` ��jj -t- � r!'
3. Date of evaluation: 4. Time of evaluation: t %
5. Name of stream: t JC0 C . `: ' IC , 4--.. 6. River basin: �tf •c , : `117 '�'
7. Approximate drainage area; oat
M
ti's � frill Rt.+f '�'`� 8. Stream order:
9. Length of reach evaluated: ti 1,00 L'r 10. County:
11. Site coordinates (if known): prefer in decimal degrees,. 12. Subdivision name (if any
Latitude (ex. 34.8723I2 ): 05 6. 0a-. Lo ngitude (ex. - 77.556611): 7 ' 65?
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo /GI5 Cdt'he-r-GD Other
13. Location of reach under evaluation (note nearby roads and landmarks and attar rxiap identifying stream(s) location): j
ICA, ��, h•n'i.) WA ti Q � � .rs � >.^;"Y`.e� -�r'�� ol c�i 4`� ...�ta^ 29, d,%� :C.%J
S� v.
14. Proposed channel work (if any):,_c
15. Recent weather conditions:
16. Site conditions at time of visit:�ti'' -'' `•,
17. Identify any special waterway classifications known: !Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters Nutrient Sensitive Waters w• Water Supply Watershed. V (I -IV)
18. Is there a pond or lake located upstream of the evaluation point? YECN- If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NO 20. Does channel appear on USDA Soil Survey? YE NO
21. Estimated watershed land use: 30/c Residential _% Commercial T% Industrial J-% Agricultural
q5% Forested LS' % Cleared / Logged _% Other ( }
22. Bankfull width: a- 23. Bank height (from bed to top of bank):'
24. Channel slope down center of stream: Flat (0 to 2 %) '!Gentle (2 to 4 %) _Moderate (4 to 10 %) _,_,_Steep ( >10 %)
25. Channel sinuosity: Straight _Occasional bends ✓Frequent meander Very sinuous TBraided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ccorcgion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Evaluator's Signature �� G8 M, ;r Date tl
This channel evaluation form is inters a to be used only as a guide to assist landowners and envir nmen al professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change - version 06/03. To Comment, please call 919 -876 -8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastai streams.
KBU`F0NJ?01N
CnAR,,WM- RIS74C
'kXNGF,
..e�t
?
3
-4
6
7
13
rsWt
PrRencc of now / pe' i exit Pools kytream I 0
1-110 flow or salwatiou st, haw K-111fs)
E idenciofpast' human alteration
-ina-; points) i " 6 I !} -
F
-� ar max Epints)-
(no buffer Onckn'Ulyuvus,
VVIdenie ofoutAcrit or chenAical discharges 0-4
ye &Jkh, -Z no-discbarg6 `,,Max-pdinw —T.
G ro undvm.te-r discharge 0 0- 4
ino dis spdng• ?, -seers. '*N eWa&ac, - I-Aax p6irt ,)
Presence of adjacent floodplain 0-4 0,.;; 4
n(, i(oodplatn f: 0 VC niax paiL�T
Entrenchment! floodplain actvi% 0-5 i 0 -,4
'deeply enuenchod =,O,-fi Outnt fluoding ilia
Presence of adjacent -A-etlands. b - 0-4
no wetlands = OrfiirZc ad Lkep i weclUnd-o vlar. phi -,10
i%han5iel �i�ivasi�y -� 0- 4
P
Sedhaent Input O�- 4
6 -�Ili '. '')' 5
(eX t C ae�cj5'1�0n-7 EffIV01i " Ma
d' ersift of channel toed substrate Size & 1,� *1A 0-4
oi6ts)'-
Evidence of-channel ineigiun or widening 0---S �0-4
Presence of ma'I'D'r bank Whites 0-5
Pres V - 5
6--vere etopon 0; ito -efOsklil. ' t--ble [MI-8 = May- 2060
i�
0- 5
W- 4
W- 4
0'- 2
2
k o , �?
0-4
0-f
-
0-5
O_5
zo�
14
Root depth and denilty on banks
- O!,d6rig, i i x 0
no visible roots `i?)(As 114029.11021- ra P * )
Impact by; agrlcultuje, livestockorduiber production 4-s 0 -
-5
0-5
41
4-4
10
120
-
[23
(subsWrattaf impaU 601• u6 evi&nci Points) .—'—'--17
Ptesence of riffle-pooMipple-pool tomplexes 0-1, Q-5
- 0) 1
ol, pooJ3 -= 0* Niml!-d 13011n,
Habitat complexitV
inam) Ints)
(little w no haFgax = 0' !17fi i-qlierd,,X fldd habitats � _6
Cinopy�-caverage over strearnbed 0--5 T
-Substrate embeddednem. q-4
i��!V embedded loose qtructdie = rrw,.)
Kesenct 01 Stream invertebrate-9 page 4�) 0
'(no evklcme - 0,1 conquon, numamus 9,:Jl�2F: Mi4iWinkj�'
Prerii'nee of araphiblaa6 0 -.-4- 0-4-
nummous vpzs rna.�,,points)
Piinnce offiqh 0- 1 0-4
-i no e� Me n,,,: = 0.,coirunLyn, num�rous tVPos max'poin'tt.,
--- - . I
Evidence of wildlife uige 0-6
100
0-6
0-6
0
0-4.
-
0, •
0-14
100
13
TOTAL 'SCORE Ohiko,�hieftjn`firSt P
* These characteristics are not assessed in coastai streams.

4
�tI (Ji� ��Gt �l1r&c• NC i1Wn Ctranm Irantifratinn Farm Vareinn
Date:
Project/Slte: ''`•' „ .�
tU� 2:
Latitude: !
36- 'c�
Evaluator: r2 t w
County: t b f
Longitude: _
Total Points: ,
Stream Determination circle one
Other y.R. Ca• " U`r,
Stream is at least intermittent 9,q
Ephemeral Intermittent Perennial
,
e.g. Quad Name:
if a 19 or rennial if>_ 30`
2
3
A. Geomorphology (Subtotal
Absent
Weak
Moderate
Strong
1' Continuity of channel bed and bark
2. Sinuosity of channel along thalweg
0
0
i 1
1
2
3
3
3. In- channel structure: ex. riffle -pool, step -pool,
ri ie- ool sequence
0
j
2
3
4. Particle size of stream substrate
0
0.5
2
3
5. Active /relict floodplain
0
;' 1 1
2
3
6. Depositional bars or benches
0
1
2
3
7. Recent alluvial deposits
0 ` '
1
2
3
8. Headcuts
24. Amphibians
0 °;,
2
3
9. Grade control
0
0.5
0
1.5
10. Natural valley
0
0.5
1 '
1.5
11. Second or greater order channel
"r No =
Yes =1
`artificial ditches are not rated; see discussions in manual
R Hvelrnlnnv fGuhtntal = 2 1
12. Presence of Baseflow
0
(1
2
3
13. Iron oxidizing bacteria
_. �
1
2
3
14. Leaf litter
1.5
1
0.5
0
15. Sediment on plants or debris
0
0.5
21. Aquatic Mollusks
1.5
16. Organic debris lines or piles
0
0.5
3
22. Fish
17. Soil -based evidence of high water table?
No = 0
Yes = 3�
r^ Rinlnnv (Riihtntal = 4 1
18. Fibrous roots in streambed
3.
2
1
0
19. Rooted upland plants in streambed
3';'
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
Q'Y
1
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians
0 °;,
0.5
1
1.5
25. Algae
0
0.5
�,1 ;?
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5 Oter =.'b9
Vv-:
`perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:
rr
C
4�c
i4

^ WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont Region
Project/Site: City/County: Sampling Date: i� l
Applicant/Owner: NC��i ' �' = V '� State: IQ C Sampling Point:
Investigator(s):'M 1'ycc:� s.'d�i Section, Township, Range: p
Landform (hillslope, terrace, etc.): O.1d -•q iz•4� % Local-relief (concave, convex, none): �+ i� * Slope
Subregion (LRR or MLRA): �– Lat: (_. :� Long: 25, L J Datum:
Soil Map Unit Name: _ c
-1R a .c. �.j:i s,?�,t� NWI classification:
Are climatic / hydrologic conditions on the site typical for this time of year? Yes '1-11 No (if no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes 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 k"' No Is the Sampled Area
Hydric Soil Present? Yes No within a Wetland? Yes ✓ No
Wetland Hydrology Present? Yes N puuj�y�+o o
Rema i� >�t'' k's�R `� fa
� ,
A..
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two reauired)
Primary Indicators (minimum of one is required; check all that apply)
v
_ Surface Soil Cracks (136)
Surface Water (Al) _
True Aquatic Plants (1314)
c Sparsely Vegetated Concave Surface (BB)
nHigh Water Table (A2)
H drogen Sulfide Odor (Cl)
_ Drainage Patterns (1310)
(%Saturation (A3) ✓Oxidized
Rhizospheres on Living Roots (C3)
_ Moss Trim Lines (B16)
_ 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 (CO)
_ 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 (B5)
✓Geomorphic Position (D2)
_— Inundation Visible on Aerial Imagery (137)
_ Shallow Aquitard (D3)
_ Water- Stained Leaves (B9)
_ Microtopographic Relief (D4)
_ Aquatic Fauna (1313)
_ FAC- Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No 'f
Depth (inches):
Water Table Present? Yes �_ No
�e
Depth (inches): Q_4
,
Saturation Present? Yes _ &Z No
Depth (inches): a
Wetland Hydrology Present? Yes I'll No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks: _
C :ee�� �l:r.�.�� S��y.,� ^�' ^ai' �.
` _ _ .,�,,�� �y"'•i
.S„ '"" { Clv1 ,�. j • �'`�'"'
a�
raw � \f"u.�'t�:s�� ,./�
�s IL

VEGETATION (Four Strata) - Use scientific names of plants.
} Absolute Dominant indicator
Tree Stratum (Plot size: } Cover Species? Status
irul^U'- VbN '& tO FA
3.
6.
I ,r+p, X4.:1►+! wJr'�d•' • '��
Sampling Point: ��►!' '
Number of Dominant Species
That Are OBL, FACW, or FAC: (A)
Total Number of Dominant Q
Species Across All Strata: 1 (B)
- Percent of Dominant Species
That Are DBL, FACW, or FAC: (A/8)
7.
= Total Cover
50% of total cover: 20% of total cover:
Saplina/Shrub Stratum (Plot size: 1
I. pfct,•c 1O - ✓_ re -�, "cam
2.3 oh Vol
3, v
4,
5.
7. - -
8. - —
9.
Total % Cover of:
Multiply by:
OBL species
x 1 =
FACW species
x 2 =
Total Cover
x 3 =
50% of total cover:
20% of total cover:
Herb Stratum (Plot size: }
x 5 =
Column Totals:
(A) (B)
_ _ �' _
�/
2
110
3.
Qn .v .ate
4.
�¢,t !-Ak -; % ,i;.Y c fi y�
5
1 Pt
5.
� t
6,
_
7.
-
-
8.
9.
10.
- -
11.
[�
= Total Cover
50% of total cover:
20% of total cover:
Woody
Vine Stratum (Plot size: )
FA
&0
bell
3.
its rYe , �,.u' �v G+� us` -' +:` ;�. ..:
fO
FA t`
4.
5.
�{d
=Total Cover
50% of total cover:
_ 20% of total cover:
Remarks: (Include photo numbers here or on a separate sheet.)
Prevalence Index worksheet:
Total % Cover of:
Multiply by:
OBL species
x 1 =
FACW species
x 2 =
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
_A,4 Dominance Test is >50%
_ 3 - Prevalence Index is s3.0'
_ 4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
Problematic Hydrophytic Vegetation' (Explain)
'indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (oBH), regardless of
height.
Sapling/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 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 It In
Hydrophytic
Vegetation
Present? Yes No

SOIL
to the death needed to
*' Sampling Point:
or confirm the absence of
Depth
Matrix
Redox Features
Histoso! (Al)
(inches)
Color moist)
% Color moist % Typgr
Loci Texture Remarks
_ Coast Prairie Redox (A16)
R—
'Io y2 ao
M 'z6 ��
4
_ Hydrogen Sulfide (A4)
L my Gleyed Matrix (F2)
172{ 2 s b �y
,;;
�' 1 Lri rrc.�ti
pleted Matrix (0)
(MLRA 136, 147)
_ 2 cm Muck (A10) (LRR N)
— Redox Dark Surface (F6)
_ Very Shallow Dark Surface (fF12)
_ Depleted Below Dark Surface (A11)
,-,_ Depleted Dark Surface (F7)
_- Other (Explain in Remarks)
_ Thick Dark Surface (Al2)
= Redox Depressions (178)
Sandy m1 ucky Mineral (S1) (LRR N,
r
'Type: C Concentration, D =Depletion, RM- Reduced Matrix, MS= Masked Sand Grains. zLocation: PL =Pore Lininq, M= Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric Soils3:
Histoso! (Al)
_ Dark Surface (S7)
2 cm Muck (A10) (MLRA 147)
_
_ Histic Epipedon (A2)
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_ Coast Prairie Redox (A16)
Black Histic (A3)
_ Thin Dark Surface (S9) (MLRA 147,148)
(MLRA 147, 148)
_ Hydrogen Sulfide (A4)
L my Gleyed Matrix (F2)
_ Piedmont Floodplain Solis (1719)
_ Stratified Layers (A5)
pleted Matrix (0)
(MLRA 136, 147)
_ 2 cm Muck (A10) (LRR N)
— Redox Dark Surface (F6)
_ Very Shallow Dark Surface (fF12)
_ Depleted Below Dark Surface (A11)
,-,_ Depleted Dark Surface (F7)
_- Other (Explain in Remarks)
_ Thick Dark Surface (Al2)
= Redox Depressions (178)
Sandy m1 ucky Mineral (S1) (LRR N,
_ Iron- Manganese Masses (F12) (LRR N.
MLRA 147, 148)
MLRA 136)
_ Sandy Gleyed Matrix (S4)
_ Umbdc Surface (F13) (MLRA 136, 122)
31ndicators of hydrophy[ic vegetation and
r Sandy Redox (SS)
i Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present,:
Stripped Matrix (S6)
_ Red Parent Material (F21) (MLRA 127,147)
unless disturbed or problematic:
Restrictive Layer (if observed):
Type:
Depth (inches):
4
Hydric Soil Present? Yes No

lWETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont Region
PrcJect/Sfte: l,� = ' `� �Q l 1'� y ty: C71-i 1 s"f d,, "' 4 Sampling Date:
Ck /Coun
Applicant/owner: llj �j�U -[' -�iV State: 0C- Sampling Point: WNi t4 <�V;
Investigator(s): M lZ $6 Section, Township, Range:
Landform (hillslope, terrace, etc.): Local relief (concave, convex, none): Slope
Subregion (LRR or MLRA): Lat: Long: - -A cj Lo?-, Datum:
Soil Map Unit Name: e%Nk t -iC:, NWI classification:
Are climatic / hydrologic conditions on the site typical for this time of year? Yes (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes L,*' 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
Is the Sampled Area
Hydric Soil Present? Yes No ✓ Within a Wetland? Yes No _,
Wetland Hydrology Present? Yes No ✓�
Remarks:
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 (C1)
Drainage Patterns (610)
_ Saturation (A3)
_ Oxidized Rhizospheres on Living Roots (0)
Moss Trim Lines (816)
_ 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 (131)
_ iron Deposits (B5)
_ Geomorphic Position (132)
_ Inundation Visible on Aerial Imagery (137)
_ Shallow Aquitard (03)
_ Water - Stained Leaves (139)
__Microtopographic Relief (D4)
_ Aquatic Fauna (B13)
` FAC- Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No
Depth (inches):
Water Table Present? Yes No
Depth (inches):
Saturation Present? Yes No
Depth (inches):
Wetland Hydrology
Present? Yes No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:

1ICf_9:TATrf%kl Wni rr Ctratal _ I ten crionfifir no.,,nc of ninntc
t Absolute Dominant Indicator
Tree St to {Plot size: ES, ) % Cover _Species? Status
1. Bits % ':
2. ' hXL-" '
7.
�f = Total Cover
50% of total cover: 20% of total cover:
Saplin Ir St hmb Stratum (Plot size: l
3. IM11010 06( 5 ✓
4. _
5.
6.
7.
8. -
9. —
Z Total Cover
50% of total cover: 20% of total cover:
Herb Stratum (Plot size: )
2.
3.
4.
5.
6.
7
8
9.
10.
11,
50% of total cover:
Camnlinn Dnint•1T K &A VO
Number of Dominant Species
That Are OBL, FACW, or FAC: (A)
Total Number of Dominant
Species Across All Strata: { (B)
Percent of Dominant Species ' %
That Are OBL, FACW, or FAC: & (A/B)
Total % Cover of
OBL species
FACW species
FAC species
FACU species
UPL species
Column Totals: _
Multiply bv:
x1=
x2
x3=
x4=
x5=
(A) (B)
Prevalence Index = B/A =
1 - Rapid Test for Hydrophytic Vegetation
-0'2 - Dominance Test is >50%
_ 3 - Prevalence Index is 53.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetation' (Explain)
�— 'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
0 ' = Total Cover
20% of total cover:
Woody Vine Stratum (Plot size )
IV-4 Ave, ZA,.4..C� .,.+�� J , Ve ✓ {�flAk4C/`
3. y 1
4. -
5. -
r. ;� = Total Cover
50% of total cover: 20% of total cover:
or on a separate
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 or equal to 3.28 ft (1
m) tall.
Herb - All herbaceous (non- woody) plants, regardless
of size, and woody plants less than 3.28 R tall.
Woody vine - All woody vines greater than 3.28 ft in
Hydrophytic
Vegetation
Present? Yes No

SOIL
Sampling Point:
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth
(inches)
Matrix
_ Histosol (Al)
Redox
Features
% Tvoe, Locr Tenure Remarks
Color (moist)
%
Color (moist)
_ Black Histic (A3)
_.Thin Dark Surface (S9) (MLRA 147,148)
(MLRA 147,148)
_ Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (172)
` Piedmont Floodplain Soils (F19)
— Stratified Layers (A5)
— Depleted Matrix (F3)
(MLRA 136,147) 1
2 cm Muck (A10) (LRR N)
10-11s,
T S Y N 9 i,6
(001 /4
-1,5 '.3
I ovo A IN1d t* 0iM `t 1 t" t'4154
T ,
_ Thick Dark Surface (Al2)
_ Redox Depressions (F8)
— Sandy Mucky Mineral (S1) (LRR N,
J
'Type: C =Concentration, D= Depletion, RM= Reduced Matrix, MS= Masked Sand Grains. `Location: PL =Pore Lininq, M= Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric Sofls3:
_ Histosol (Al)
_ Dark Surface (S7)
_ 2 cm Muck (A10) (MLRA 147)
_ Histic Epipedon (A2)
_ Poiyvalue Below Surface (S8) (MLRA 147,148)
_ Coast Prairie Redox (A16)
_ Black Histic (A3)
_.Thin Dark Surface (S9) (MLRA 147,148)
(MLRA 147,148)
_ Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (172)
` Piedmont Floodplain Soils (F19)
— Stratified Layers (A5)
— Depleted Matrix (F3)
(MLRA 136,147) 1
2 cm Muck (A10) (LRR N)
_ Redox Dark Surface (F6)
_ Very Shallow Dark Surface (TF12)
_ Depleted Below Dark Surface (A11)
_ Depleted Dark Surface (F7)
_ Other (Explain in Remarks)
_ Thick Dark Surface (Al2)
_ Redox Depressions (F8)
— Sandy Mucky Mineral (S1) (LRR N,
_ Iron - Manganese Masses (F12) (LRR N,
MLRA 147,148)
MLRA 136)
— Sandy Gleyed Matrix (S4)
_ Umbric Surface (F13) (MLRA 136, 122)
3Indicators of hydrophytic vegetation and
___. Sandy Redox (S5)
_ Piedmont Floodplain Soils (1719) (MLRA 148)
wetland hydrology must be present,
Stripped Matrix (S6)
_ Red Parent Material (F21) (MLRA 127,147)
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches):
Hydric Soil Present? Yes No
I IC A,m f`n of C—i—m-

WETLAND RATING WORKSHEET Fourth Version
�3�- �•ta.�� �$i2 308e,?)
Project Name QED a4s ► t� Nearest Road, i r 0J
County Wetland area 3J acres Wetland width &109 feet
Name of evaluator ' Y) ZL i :n 1 #42•cA3> + Date 11 1201
Wetland location
on pond or lake
_ on perennial stream
1/on intermittent stream
within interstream divide
other:
Soil series: r s �C.
predominantly organic - humus, muck, or
peat
_`predominantly mineral - non -sandy
predominantly sandy
Hydraulic factors
steep topography
ditched or channelized
total wetland width > 100 feet
Wetland type (select one) *
,�"Bottomland hardwood forest
Headwater forest
_ Swamp forest
_ Wet flat
_ Pocosin
Bog forest
Adjacent land use
(within' /2 mile upstream, upslope, or radius)
forested/natural vegetation :s %
!agriculture, urban/suburban 40 %
impervious surface'%
Dominant vegetation
(1) A wvt Y- uA-ary mncn,
2 <
(3) .cn'r, =-zk a c e
Flooding and wetness
semipermanently to permanently flooded or
— inundated
seasonally flooded or inundated
_,,,`fntermittently flooded or temporary surface water
no evidence of flooding or surface water
Pine savanna
Freshwater marsh
!_ Bog/fen
Ephemeral wetland
Carolina bay
Other:
The rating system cannot be applied to salt or brackish marshes or stream channels
R
Water storage
%� . x 4.00 =
J A
Bank/Shoreline stabilization
x 4.00 =
®
Wetland
T
Pollutant removal
"` x 5.00 =
rating
I
Wildlife habitat
x 2.00 =
N
Aquatic life value
x 4.00 =�
i
G
Recreation/Education
x 1.00 =
1'
* * Add 1
point if in sensitive watershed and >10% nonpoint source disturbance within
'/Z mile upstream, upslope, or radius

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p mx oD cnM c>' �0
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