20141224 Ver 1_401 Application_20141214

Robert J. Goldstein and Associates, Inc.
RJG &A ENVIRONMENTAL CONSULTANTS
1221 Corporation Parkway, Suite 100 Since 1985 Tel [phone]
Raleigh, North Carolina 27610 Fax [phone]
e -mail rgoldstein2( RJGAearolina corn website www RJGAcarolma corn
21 November 2014
Mr David Bailey
US Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trade Dr, suite 105
Wake Forest, NC 27587
Ms Karen Higgins
NC Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 - 1617
2 01 41 224
Re PCN for Dan River Intake and Yanceyville Raw Water Line, Caswell Co (Roanoke River basin)
Dear US -ACE and NC -DWR Staff ,
Attached is the Section 404 -401 PCN and supporting documentation for the Town of Yanceyville's
proposed water intake on the Dan River near the Town of Milton and raw water pipeline from the intake
to Yanceyville's existing water treatment plant located on Badgett Sisters Parkway south of Yanceyville
The City of Roxboro, Person County, and Caswell County have established an inter -local partnership to
develop this long -term regional resource Roxboro is leading the project and is the PCN applicant, but
Yanceyville is the owner of the intake property
The project scope for this PCN is a portion of a larger regional water supply project documented in a
2006 SEPA EA- FONSI, which includes an additional pipeline to deliver raw water line to the Roxboro WTP
reservoir and a package WTP and potable water line connecting to Milton's distribution system Only
the intake access road, intake channel, and building pad for the pump station (Phase 1) will be built in
the near future (2015) The intake screens, pumping facilities, and raw water line to the Yanceyville
WTP (Phase 2) are included in this PCN application to fulfill the permitting requirement of a complete
and independent project Those facilities will not be designed and built for at least 5 to 10 years, and
the plans and impacts for those components as provided in the PCN are thus preliminary The Roxboro
and Milton project components are also at least 5 to 10 years away The applicant is aware that the
permit authorization will likely expire before Phase 2 construction begins and may need to be re-
permitted at that time
The Phase 1 impacts to waters and wetlands include 1) a permanent culvert with headwalls and riprap
dissipators at the inlet and outlet on an intermittent stream (intake access road crossing), 2) permanent
excavation of 0 08 acre of isolated wetland on the Dan River floodplain (intake channel), 3) a temporary
NEPA & SEPA Environmental Documents EA, EIS, CE 3 Jurisdictional Welland & Stream Buffer Delineations ® 404 - 401 Permits ® GISIGPS Mapping
® Water Quality Studies ZyStream & Wetland Mitigation and Restoration ® Endangered Species Surveys ® Biological Assessments & Conservation Plans
® Water Intakes & Reservoirs ® Water Lines & Treatment Plants ® Seiverlmes & Wasteivater Treatment ® Instream Floiv Analyses ® Interhasin
Transfer Certificates ® Watershed Assessment & Management ®Archaeological Surveys and Testing ® Phase I Site Assessments LT Parks & Greemvays
Planning ® CWMTF Grant Applications

Robert J. Goldstein and Associates, Inc.
RJG &A ENVIRONMENTAL CONSULTANTS
cofferdam in the river for dewatering the intake construction area, 4) excavation of the river bank to
create a 2 1 (Horiz Vert) slope, and 5) placement of articulated block armoring on the re- graded river
bank
The Phase 2 impacts to waters and wetlands (estimates based on current preliminary design) include
five wetland crossings and five stream crossings along the future raw water line to Yanceyville
Installation of the trash rack and - ,screen at the mouth of the intake may also have some minor impact,
not quantified at this time " More detailed plans and impacts for the Phase 2 components will be
provided at that time ;
1 1 �
The State Historic Preservation, Office (SHPO) sent a response to RJG &A's scoping letter stating that no
archaeological survey would be needed, but they would like more detailed plans for the water line along
NC -62 whe q_ij will run pas four historic sites The requested information will be provided to SHPO
during design of the water line, probably in 5 to 10 years
RJG &A is also coordinating with US -FWS, NC -NHP, and NC -WRC regarding endangered species and
fishery protection issues The intake will meet their recommended velocity and screen mesh standards
for waters supporting anadromous fish species (Striped bass and American shad) We are awaiting the
US -FWS response to our opinion regarding potential impacts to endangered species
Feel free to email or call me or Paul Stimpson at LaBella Engineering (formerly 1 N Pease Associates) if
you have any questions about this project and its impacts to Jurisdictional waters or other resources
Sincerely,
A" ".Z7
Gerald Pottern, senior biologist
Rpottern @RJGAcarolina com
919 - 872 -1174
Copies To NC -DWR 401- Buffer Permitting (4 copies + 401 Review Fee Check)
Paul Stimpson, LaBella Engineering
Tommy Warren, City of Roxboro
Page 2

OF 1�1AZ� -9
�, �qG Office Use Only
t i
__0 �r Corps action ID no
o c DWQ project no
Form Version 1 3 Dec 10 2008
2
Pre - Construction Notification (PCN) Form
A
Applicant Information
Dan River Water Intake and Yanceyville Raw Water Line
2b
1 Processing
Caswell
la
Type(s) of approval sought from the
®Section 404 Permit ❑Section 10 Permit
2d
Subdivision name
Corps
2e
NCDOT only, T I P or state
project no
1b Specify Nationwide Permit (NWP) number NWP -12 or General Permit (GP) number
3
1c
Has the NWP or GP number been verified by the Corps?
® Yes Eric Alsmeyer ❑ No
1 d
Type(s) of approval sought from the DWQ (check all that apply)
3b
Deed Book and Page No
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le
Is this notification solely for the record
For the record only for DWQ 401
For the record only
for Corps Permit
because written approval is not required?
Certification
❑ Yes ® No
❑ Yes
® No
1f
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
❑ Yes
® No
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program
1g
Is the project located in any of NC's twenty coastal counties If yes, answer 1 h
❑ Yes
® No
below
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)
❑ Yes
®No
2
Project Information
2a
Name of project
Dan River Water Intake and Yanceyville Raw Water Line
2b
County
Caswell
2c
Nearest municipality / town
Milton to Yanceyville
2d
Subdivision name
NA
2e
NCDOT only, T I P or state
project no
NA
3
Owner Information
3a
Name(s) on Recorded Deeds
Intake Property and WTP Property Town of Yanceyville Off -road parcels between
Moorefield Rd and WTP (a) State of NC, (b) Town of Yanceyville, (c) R A Rogers
Family LTD Partnership Many owners along NC -62 roadside waterline (9 miles)
3b
Deed Book and Page No
Deed Book 15, Page 194 (intake property)
Page l of 14
PCN Form — Version 1 3, Dec 2008

3c
Responsible Party (for LLC)
Brian Collie, Yanceyville Town Manager
3d
Street address
158 East Church Street, Yanceyville NC 27379
3e
Mailing Address
PO Box 727, Yanceyville NC 27379
3f
Telephone no
336 - 694 -5431
3g
Fax no
336 - 694 -1499
3h
Email address
townmanagergyanceyvtllene gov
4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent ® Other, specify City of Roxboro
4b
Name
Thomas S Warren Jr, Roxboro Assistant City Manager
4c
Business name
City of Roxboro
4d
Street address
P O Box 128
4e
City, state, zip
Roxboro NC 27573
4f
Telephone no
336 -503 -0489
4g
Fax no
336 -503 -0588
4h
Email address
twarren @cityofroxboro corn
5
Agent/Consultant Information (if applicable)
5a
Name
Gerald Pottern (Environmental Consultant, Permitting Agent)
5b
Business name
Robert J Goldstein & Associates, Inc
5c
Street address
1221 Corporation Pkwy, suite 100
5d
City, state, zip
Raleigh, NC 27610
5e
Telephone no
919- 872 -1174
5f
Fax no
919 - 872 -9214
5g
Email address
gpottern @RJGAcarolma com
6a
Name
Paul Stimpson, P E (Engineering Consultant)
6b
Business name
Pease Engineering & Architecture, P C
6c
Street address
121 West Innes Street, Suite B
6d
City, state, zip
Salisbury, N C 28144
6e
Telephone no
(704) 754 -5158
6f
Fax no
6g
Email address
pstimpson @pease -ae com
Page 2 of 14
PCN Form — Version 1 3, Dec 2008

B.
Project Information and Prior Project History
1 Property Identification
1a
Property identification no (tax PIN or parcel ID)
Dan River Intake Site PIN 0106 0000 0142 + 0106 0000 0143
lb
Site coordinates (decimal degrees) (pump sta)
Latitude 36 5332 Longitude -79 2195
1c
Property size
Intake property = 21 7 acres
2 Surface Waters
2a
Name of nearest body of water (stream, river, etc)
Dan River + unnamed tributary
2b
Water Quality Classification of nearest receiving
water
Dan River above intake = Class WS- IV -CA, Dan River below
intake and unnamed tributary = Class C
2c
River basin
Dan /Roanoke River DWQ 03- 02 -04, USGS 03010104
3 Project Description
3a Describe the existing conditions on the site and general land use in the vicinity of the project at time of this application
The 22 -acre intake property is bounded by the Dan River to the northwest, a Duke Energy powerlme to the south, and an
unnamed tributary to the east and north Elevations on the site range from 350 feet at the edge of the river (OHWM) to 480 feet
on the highest ridge The property is roughly two - thirds forested and one -third cattle pasture The forested areas support a mix of
mesic hardwood and alluvial forest trees including Sweetgum, Red maple, Tulip poplar, Musclewood, Box elder, Sugarberry,
Willow oak, Red oak, Beech, Loblolly pine, Eastern redcedar, Sycamore, and Paulowma An abandoned railroad embankment
(tracks and cross -ties have been removed) parallels the river about 140 ft from the edge of water (OHWM) A steep ravine in
the west - central portion of the site contains a small isolated wetland (approx 0 08 acre) on the southeast side of the railroad
embankment where drainage is impeded Flow from this wetland enters a culvert under the railroad embankment, then
disappears into the soil on the levee northwest of the culvert, there is no apparent channel connecting it to the river The river
bank at the intake site is moderately steep, with no adjacent wetland Adjacent land uses are rural - residential and agricultural
The proposed access road corridor from NC -62 westward to the intake site traverses 980 feet of pasture, then crosses a 6 ft wide
intermittent or perennial stream at the east edge of the intake site This small stream flows northeast and northward into the Dan
River at the northern edge of the property The stream bed comprises bedrock steps and pools with sand and silt, and the stream
banks are relatively steep, with no adjacent wetland in the vicinity of the road crossing The upper reach of this stream (south of
the proposed road crossing) is impounded by a farm pond located between the powerlme and the proposed access road
The raw water line along NC -62 from the intake site to Yanceyville will be constructed mostly within or adjacent to the NC -62
right -of -way, which follows a ridgelme The exact construction corridor has not yet been determined, as this line will not likely
be built for at least 5 or 10 years The preliminary alignment shown in the EA was selected to minimize environmental impacts,
and follows the west side of NC -62 from the intake access road southward to a point 1200 feet north of Archie White Rd, then
switches to the east side of NC -62 from that point southward to Moorefield Rd Assuming the construction corridor will extend
ten feet beyond the highway right -of -way (worst -case scenario), this segment crosses three headwater seep wetlands Adjacent
land uses along this road are primarily rural residential and agricultural, with some commercial and institutional development in
the Town of Yanceyville near the southern end of the project The last mile of raw water line, from Moorefield Rd west to the
Yanceyville WTP, traverses mostly upland hardwood and mixed pine- hardwood forest (some areas recently clearcut), with five
stream crossings and two wetland crossings Several homes are located along Moorefield Rd, mostly on the north side The
proposed corridor also crosses the Yanceyville WWTP property, midway between Moorefield Rd and the WTP
Page 3 of 14
PCN Form — Version 1 3, Dec 2008

3b List the total estimated acreage of all existing wetlands on the property
RJG &A biologist Gerald Pottern examined the intake site and raw water line corridor for wetlands and waters during Oct 2014
RJG &A had previously examined most of this area in 2004 -2005 during preparation of the SEPA EA, except that the previously
examined intake site was a few hundred feet upstream (southwest) from the current intake site The ravine in the middle of the
intake site contains a small isolated wetland (0 070 acre) where the old railroad embankment restricts drainage Outflow from
this wetland flows northwest through a 60 -ft long culvert under the railroad embankment into a 0 008 acre linear wetland, then
dissipates into non- hydric soils 45 feet west of the culvert outlet, about 70 feet from the edge of the river There is no apparent
surface hydrology connection (channel or wetland) between the wetland and the river at normal river flow elevations (about 350
feet) During high flow events the river may rise to the elevation of the wetland (365 feet) This wetland (on both sides of the
railroad embankment) contains primarily shrub and herb vegetation with few trees, but is shaded by large trees rooted in the
adjacent non - wetland forest
The raw water line corridor along NC -62 between the intake site and Moorefield Rd (preliminary alignment, 10 -ft wide adjacent
to highway R -O -W) crosses two linear wetland ditches and one small headwater seep wetland (total 0 0372) acre in construction
corridor) From Moorefield Rd west to the Yanceyville WTP, the off -road preliminary corridor (20 -ft wide) crosses two
additional alluvial wetlands (total 0 0405 acre in construction corridor) These wetlands are contiguous with streams
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
The intake property includes 2,300 feet of frontage along the southeast (right) bank of the Dan River, most of which is forested
The near -shore river bed is predominantly silt and fine sand, the deeper off -shore river bed was not visible The intake property
also includes 900 linear feet of a 5 to 8 foot wide intermittent or small perennial tributary flowing northward into the Dan River
The bed of this stream is primarily bedrock with silt and sand deposits in pools, the stream banks are forested
The raw water line corridor between the intake site and Moorefield Rd (preliminary alignment) follows a ridge and does not
cross any streams with an OH WM From Moorefield Rd west to the Yanceyville WTP, the off -road preliminary corridor
crosses five southward - flowing tributaries of Country Line Creek, with widths of 10, 8, 12, 15, and 5 feet Using a 20 -11 wide
temporary disturbance corridor, the total stream channel length within this corridor segment is approximately 115 feet
3d Explain the purpose of the proposed project
The Town of Yanceyville has purchased a 22 -acre site along the Dan River near Milton in northeastern Caswell County to
construct a public raw water intake Yanceyville, Caswell County, City of Roxboro, and Person County established an inter -
local agreement in 2003 to develop this intake as a long -term regional water source to serve the two counties and their
municipalities The intake channel, pump station building pad, and access road off NC -62 are being designed and scheduled to
be built during summer -fall 2015 The pump house, pumping facilities, and raw water lines will be designed and built at least 5
to 10 years later as water demand grows For budgeting purposes the municipalities plan to build just the Phase 1 facilities at
this time (intake channel, building pad, and access road) Eventually raw water lines to Yanceyville's and Roxboro's existing
WTPs will be built, and a small package WTP will be installed on the intake property with a potable water line connecting to the
Town of Milton's distribution system Roxboro and Yanceyville currently rely on impoundments constructed on smaller
streams (Roxboro's City Lake and Yanceyville's Farmer Lake) which have adequate safe yield for now, but will eventually need
to be supplemented as the population grows in Caswell and Person Counties Milton relies on a public groundwater well system
with limited yield The Dan River intake will provide a much greater safe yield and is expected to meet the region's water needs
for 50 years and beyond
Page 4 of 14
PCN Form — Version 1 3, Dec 2008

3e Describe the overall project in detail, including the type of equipment to be used
Intake Site Construction Sequence: 1 Install erosion and sediment control features along the intake access road corridor, and
begin grading the access road (see plan sheet) 2. Clear the Stream -1 crossing area and dewater this stream segment with a
temporary cofferdam and bypass pipe, dewatermg may not be needed if construction can be done while the stream has no flow
3 Excavate the stream bed as needed to install a permanent 54" diam RCP culvert (102 feet long), concrete headwalls, and
riprap approach at the culvert inlet and outlet (total length = 148 ft) 4. Place fill for the access road over the culvert, allowing
construction vehicle access to the western part of the intake property 5 Install erosion and sediment control features on the
intake site, and clear and grub the western segment of the proposed access road, the pump station area, and intake channel area
6 Excavate the intake channel, except for the last 40 feet closest to the river, and grade a 12 -11 wide access road on each side of
the channel 7. Armor the channel slopes with articulated block from the bed up to OHWM elevation (341 to 350 ft), and install
Curlex or similar matting to support grass establishment on the channel access roads and upper slopes (350 to 370 ft) The
partial intake channel will serve as a temporary stormwater basin during the remainder of construction (see plan sheet) 8 Use
the excavated soil to complete grading along the access roads, pump station site and parking area 9. Clear and grub the borrow
& fill areas north and south of the access road, taking additional fill material as needed for access roads and intake site grading
10. Construct the concrete section of the intake channel and adjoining base pad for the future pump station 11 All disturbed
soil areas on the intake site will be stabilized with matting and vegetation prior to excavation of the final intake channel tie -in to
the river 12. Install a temporary cofferdam approximately 175 feet long parallel to the river bank using approximately 260
cubic yards of surge stone, concrete Jersey barriers on top of the surge stone, and polyethylene sheeting anchored with
additional rock 13 Dewater the near -bank construction area (approximately 155 feet long and 10 to 15 feet wide) using sump
pumps and silt sacks or other appropriate silt- removal devices 14 Remove accumulated sediment from the partial intake
channel 15. Excavate the dewatered river bank to create a 2 1 slope (approx 2,250 cu yds) and tie -in to the previously
excavated channel, and install articulated block on the lower slopes and Curlex or similar matting on the upper slopes as
specified in step 7 above 16. Remove the cofferdam materials down to the natural river bed and allow the dewatered area and
new intake channel to fill from the river
Raw Water Line Construction Sequence: Design plans for the raw water line are not expected to be developed for at least 5
to 10 years, as the municipalities expect to have adequate water yield from their existing sources until then Future development
along NC -62 including road improvements and installation of other utilities may affect the final pipeline alignment chosen
Changes in construction technology and NC -DENR standards may also affect the water line location and design The following
description is therefore generic and preliminary 1 Install appropriate erosion and sediment control features along each
pipeline segment 2. Perform clearing of the construction corridor where needed (many roadside segments are bordered by non -
forested land where minimal clearing is needed) 3. Excavate the pipeline trench to the appropriate depth, with appropriate side
slopes and /or bracing, and stockpile the topsoil 4. install bedding stone, then position each pipe segment and seal it to the
previously placed segment 5 Backfill the trench, replace topsoil, and seed the disturbed soil with appropriate grass or other
groundcover seed mix 6 Segments crossing streams and wetlands maybe installed using directional boring or other trenchless
technology if feasible and cost - effective, to be determined on a site -by -site basis If open - trenching is used at streams or
wetlands, the area will be dewatered with portable cofferdams and pumps prior to excavation 7 Temporary culverts with earth
or stone fill or timber mats may be needed for vehicle access at some of the stream and wetland crossings between Moorefield
Rd and Badgett Sisters Parkway (east of the WTP) Any temporary fills in these areas will be removed upon completion of the
crossing and disturbed areas reseeded with appropriate groundcover
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Yes ®No ❑
❑ Unknown
Corps or State been requested or obtained for this property /
❑ Yes ® No ❑ Unknown
project (including all prior phases) in the past?
4b If the Corps made the jurisdictional determination, what type
❑ Preliminary ❑ Final
of determination was made?
4c If yes, who delineated the jurisdictional areas?
Agency /Consultant Company
Name (if known) Gerald Pottern (consultant)
Other Robert J Goldstein & Assoc (RJG &A)
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the pasty
Yes ®No ❑
❑ Unknown
Page 5 of 14
PCN Form — Version 1 3, Dec 2008

5b If yes, explain in detail according to "help file" instructions NA
6 Future Project Plans
6a Is this a phased projects
® Yes ❑ No
6b If yes, explain The intake channel, pump station building pad, and access road is scheduled to be built in 2015 The
pumping facilities and raw water line to Yanceyville will be constructed at least 5 to 10 years laters, based on current
population growth and water demand projections The applicant is aware that the permit authorization will likely expire
before Phase 2 construction begins, and may need to be re- permitted at that time
C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
® Wetlands ® Streams - tributaries ❑ 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
2b
2c
2d
2e
2f
Wetland impact #
Perennial
Type of jurisdiction
Average
Type of jurisdiction
number -
Permanent (P) or
Type of impact
Type of wetland
Forested
(Corps 404, 10
Area of impact
Temporary T
& Figure #
if known
intermittent
DWQ non -404, other
acres
W1 ®P ❑ T
excavate intake
isolated floodplam
® Yes
❑ Corps 365332
YG = 0 078
(feet)
channel, Fig 6
depression
❑ No
® DWQ 792194
❑ PER
W2 ❑ P ®T
roadside pipeline
linear wetland
❑ Yes
® Corps 364942
ditch = 0 0081
® INT
crossing, Fig I IA
(ditched seep)
® No
❑ DWQ 792417
riprap at culvert
W3 ❑ P ®T
roadside pipeline
linear wetland
® Yes
® Corps 364703
ditch = 0 0034
ends, Fig 7
crossing, Fig I i B
(ditched seep)
E] No
E] DWQ 792607
W4 ❑ P ® T
roadside pipeline
headwater seep
® Yes
® Corps 364195
YD = 0 0257
25 ft
crossing, Fig 11C
crossing, Fig 11D
❑ No
❑ DWQ 792960
❑ DWQ 793378
W5 [:]POT
off -road pipeline
alluvial wetland
® Yes
® Corps 363923
YE = 0 0214
® Corps 363943
crossing, Fig I ID
20 ft
❑ No
❑ DWQ 793472
W6 ❑ P ® T
off -road pipeline
alluvial wetland
❑ Yes
® Corps 363937
YF = 0 0191
crossing, Fig I ID
® No
❑ DWQ 793421
2g. Total wetland impacts 10 -ft roadside corridor, 20 -ft off -road corridor)
0.1557 acre
2h Comments 404 Wetlands = 0 0777 acre temporary impact, Isolated wetlands = 0 078 acre permanent impact.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted
3a
3b
3c
3d
3e
3f
3g
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
& Figure #
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404, other)
width
(linear
Temporary (T)
(INT)?
(feet)
feet)
S1 ® P ❑ T
culvert for access
UT Dan River
❑ PER
® Corps 365320
6 ft
102 ft
road, Fig 7
® INT
❑ DWQ 792177
S1 ® P ❑ T
riprap at culvert
UT Dan River
❑ PER
® Corps 365320
6 ft
46 ft
ends, Fig 7
® INT
❑ DWQ 792177
S2 ❑ P ® T
off -road pipeline
UT Jail Branch
❑ PER
® Corps 363945
loft
25 ft
crossing, Fig 11D
® INT
❑ DWQ 793378
S3 ❑ P ®T
off -road pipeline
UT Jail Branch
❑ PER
® Corps 363943
8 ft
20 ft
crossing, Fig I ID
® INT
❑ DWQ 793394
Page 6 of 14
PCN Form - Version 1 3, Dec 2008

S4 ❑ P ® T
off -road pipeline
Jail Branch
® PER
® Corps 363937
12 ft
20 ft
4e
crossing, Fig 1 l D
Name of waterbody
❑ INT
❑ DWQ 793421
Excavated
impact number –
S5 ❑ P ® T
off -road pipeline
UT Country Line
® PER
® Corps 363928
15 ft
25 ft
crossing, Fig I ID
Cr
❑ INT
❑ DWQ 793456
S6 ❑ P ® T
off -road pipeline
UT Country Line
❑ PER
® Corps 363926
5 ft
25 ft
Bed + bank excavation
crossing, Fig 1 1 D
Cr
® INT
❑ DWQ 793464
Articulated block armoring
River shoreline
0 009 acre
❑ Yes ❑ No If yes, permit ID no
(for intake channel construc)
Lat/Long = 36 5337, 79 2199
51 Size of pond watershed (acres)
3h Total stream and tributary impacts: 148 ft culvert +riprap; 115 ft pipeline crossings
263 ft
31 Comments Dan River intake construction impact is considered an Open Waters impact, below
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 individually list all open water impacts below
4a
4b
4c
4d
4e
Open water
Name of waterbody
Flooded
Filled
Excavated
impact number –
(if applicable)
Type of impact
Waterbody type
Area of impact
Permanent (P) or
& Figure #
(acres)
T
—Temporary
01 ❑ P ®T
Dan River, Fig 8
Temp cofferdam in river
River shoreline
0 045 acre
01 ®P ❑ T
Dan River, Fig 8
Bed + bank excavation
River shoreline
0 051 acre
01 ®P ❑ T
Dan River, Fig 8
Articulated block armoring
River shoreline
0 009 acre
❑ Yes ❑ No If yes, permit ID no
(for intake channel construc)
Lat/Long = 36 5337, 79 2199
51 Size of pond watershed (acres)
Perm = 0 051 acre
4L Total open water impacts
Temp = 0 045 acre
4g Comments The cofferdam impact comprises a footing of surge stone 10 feet wide with concrete "Jersey barriers" set on top
and plastic sheeting over the barriers and stone It will remain in place until intake channel construction and stabilization of all
exposed soil areas are complete The articulated block bank armoring will be on the same footprint as the excavated area and is
thus not added to the total impact area Excavation areas and block placement areas in the intake channel beyond the existing
OHWM of the river (350 -ft contour) are not counted as impacts
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
Flooded
P1
P2
5f. Total
NA
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes, permit ID no
51 Expected pond surface area (acres)
51 Size of pond watershed (acres)
5k Method of construction
Page 7 of 14
PCN Form — Version 1 3, Dec 2008

6 Buffer Impacts (for DWQ)
or Waters of the State
2a Does the project require Compensatory Mitigation for
❑
If project will impact a protected riparian buffer, then complete the chart below If yes, then individually list all buffer impacts
below If any impacts require mitigation, then
you MUST fill out Section D of this form
2b If yes, mitigation is required by (check all that apply)
6a
DWQ ❑ Corps
❑ Neuse E:1 Tar-Pamlico
❑Other
Project is in which protected basin?
2c If yes, which mitigation option will be used for this project?
❑ Catawba ❑ Randleman
Payment to in -lieu fee program
6b
6c
6d
6e
6f
6g
Buffer impact #
Permanent (P) or
Reason for impact
Buffer mitigation
Zone 1 impact
Zone 2 impact
Temporary T
Stream name
required?
(square feet
(square feet
61 ❑P ❑T
E] Yes
❑ No
6h Total buffer impacts
NA
61 Comments
D Impact Justification and Mitigation
1 Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
The selected intake site has a natural ravine with a lower bank profile than other sites along the river bank, thus minimizing the
required excavation and land disturbance, and reducing the potential for bank erosion into the river during construction A small
isolated wetland in the ravine (probably created by the railroad embankment) and a small stream crossing along the access road are
unavoidable The intake velocity and screen design will meet NC -WRC guidelines for fish protection in the Dan River NC
Division of Land Quality has reviewed and approved the erosion and sedimentation control plan for the Phase 1 intake construction
The Yanceyville raw water line will be mostly routed along NC -62 which follows a ridgeline between watersheds, thus minimizing
stream and wetland impacts The off -road segment from Moorefield Rd to the WTP will use a narrow construction corridor (20
feet) and directional boring for stream and wetland crossings to the extent practicable (Construction design for this water line will
not be completed for at least 5 years, water line impacts described in this PCN are preliminary)
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
The approved erosion and sedimentation control plan includes multiple temporary sediment banns and check dams along the access
road Contractor requirements for maintenance and inspection of erosion and sedimentation BMPs are specified in the plans The
eastern (off - river) portion of the intake channel will be excavated first, and will serve as a temporary skimmer basin during
construction Disposal sites for excess excavated soil are located on -site Clearing and excavation at the river bank and tie -in to the
intake channel will not begin until all other construction areas have been graded, matted, armored, and soil is stabilized A
temporary cofferdam and pumps will be installed in the river to isolate and dewater the intake channel construction area and to
minimize erosion, turbidity, and potential concrete toxicity in the river
2 Compensatory Mitigation for Impacts to Waters of the U S
or Waters of the State
2a Does the project require Compensatory Mitigation for
❑
Yes ® No
impacts to Waters of the U S or Waters of the State?
2b If yes, mitigation is required by (check all that apply)
❑
DWQ ❑ Corps
❑
Mitigation bank
2c If yes, which mitigation option will be used for this project?
❑
Payment to in -lieu fee program
❑
Permittee Responsible Mitigation
Page 8 of 14
PCN Form — Version 1 3, Dec 2008

3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank NA
3b Credits Purchased (attach receipt and letter)
�ype (NA)
Quantity (NA)
3c Comments NA
4 Complete if Making a Payment to In -lieu Fee Program
a Approval letter from in -lieu fee program is attached
❑ Yes
b Stream mitigation requested
(NA) linear feet
c If using stream mitigation, stream temperature
❑ warm ❑ cool ❑cold
d Buffer mitigation requested (DWQ only)
NA square feet
e Riparian wetland mitigation requested
NA acres
f Non - riparian wetland mitigation requested
NA acres
g Coastal (tidal) wetland mitigation requested
NA acres
h Comments
Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan
NA
6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
b If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
Zon
e
c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
NA
NA
3 (2 for Catawba)
NA
Zone 2
NA
NA
1 5
NA
6f Total buffer mitigation required
NA
g If buffer mitigation is required, 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) NA
h Comments NA
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 riparian buffers identified
within one of the NC Riparian Buffer Protection Rules?
❑ Yes ® No
Page 9 of 14
PCN Form — Version 1 3, Dec 2008

1 b
If yes, then is a diffuse flow plan included2 If no, explain why
❑ Yes ❑ No
® Yes ❑ No
2 Stormwater Management Plan
3b Which of the following locally - implemented stormwater management programs
2a
What is the overall percent imperviousness of this project?
4 2% (= 0 92 / 21 7 ac)
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan, explain why
2d
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
See attached table of stormwater basin design calculations below, Figures 10A -D, and NC Division of Land Quality approval
letter for the project erosion & sedimentation control plan, attached
2e
Who will be responsible for the review of the Stormwater Management Plan'?
❑ Certified Local Government
❑ DWQ Stormwater Program
® DWQ 401 Unit
3 Certified Local Government Stormwater Review
3a In which local government's jurisdiction is this project9
Caswell County
® Yes ❑ No
❑ Phase II ❑ NSW
3b Which of the following locally - implemented stormwater management programs
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
® Yes ❑ No
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4 DWQ Stormwater Program Review
❑ Coastal counties
4a Which of the following state - implemented stormwater management programs apply
❑ HQW ❑ ORW
(check all that apply)
❑ Session Law 2006 -246
❑ Other
4b Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
5 DWQ 401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet the appropriate requirements?
® Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
® Yes ❑ No
F Supplementary Information
1 Environmental Documentation (DWQ Requirement)
la Does the project involve an expenditure of public (federal /state /local) funds or the
® Yes ❑ 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 ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
Page 10 of 14
PCN Form — Version 1 3, Dec 2008

1c If you answered "yes" to the above, has the document review been finalized by the
5a Will this project occur in or near an area with federally protected species or habitat?
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
® Yes ❑ No
letter )
5c If yes, indicate the USFWS Field Office you have contacted
Comment A SEPA EA -FONSI for a larger version of this project (including water supply to Roxboro and Milton) was
completed in 2006, but the project was put on hold due to the economic recession RJG &A is currently preparing a SEPA
update letter that will be re- circulated via NC -DWR and State Clearinghouse along with the 2006 EA -FONSI
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,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b Is this an after - the -fact permit application?
❑ Yes ® No
2c If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s) NA
3 Cumulative Impacts (DWQ Requirement)
3a Will this project (based on past and reasonably anticipated future impacts) result in
® Yes ❑ No
additional development, 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
This project will support population growth in the water service areas in Caswell and Person Counties The population and water
demand projections used in the 2006 EA were developed prior to the recent economic recession, and will likely occur 10 or more
years later than the dates given in that document Local regulatory and non - regulatory programs to mitigate adverse environmental
impacts of new development and conserve water resources are summarized in the 2006 EA, but will obviously need to be revised
and updated to meet future changes in regulatory requirements and best available technology This project is not expected to begin
delivering water for at least 5 to 10 years
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 subject facility
This project will not generate any on -site sanitary wastewater Raw water drawn at this intake will eventually be treated and used
by Yanceyville, Roxboro, and elsewhere in Caswell and Person Counties as their water distribution systems expand The
municipalities and counties will eventually need to expand their wastewater collection and treatment systems as needed to keep pace
with potable water system expansion
5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or habitat?
❑ Yes ® No
5b Have you checked with the USFWS concerning Endangered Species Act impacts?
® Yes ❑ No
5c If yes, indicate the USFWS Field Office you have contacted
® Raleigh ❑ Asheville
Page 1 l of 14
PCN Form —Version 1 3, Dec 2008

5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
US -FWS and NC -NHP online databases report two federally endangered species likely to occur in Caswell County The
Roanoke Logperch occurs upstream in the Dan, Smith, and Mayo Rivers in Rockingham County and in the short segment of
Dan River in the northwest corner of Caswell County, upstream of Danville, VA The James Spmymussel occurs upstream in
the Dan and Mayo Rivers in Stokes and Rockingham Counties, and is listed as "potential" in Caswell County, where it might
occur in the short river segment in the northwest corner of the county There is no report of either Roanoke Logperch or James
Spmymussel from the Dan River downstream of Danville VA, where the river gradient becomes flatter and more sand -
dominated, with few areas of gravel and cobble habitat Based on the habitat change, lack of species records, and the recent
coal ash spill, it is unlikely that these two species presently occur in the Dan River in northeastern Caswell County RJG &A
submitted a scopmg letter to US -FWS and NC -WRC, and we will forward their responses to ACE and DWR upon receipt
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitats
❑ Yes ® No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NC -DMF and NC -WRC have not designated any Essential Fish Habitat in Caswell County
7 Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this project occur in or near an area that the state, federal or tribal governments have
designated as having historic or cultural preservation status (e g , National Historic Trust
® Yes ❑ No
designation or properties significant in North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
The NC State Historic Preservation Office (SHPO) reviewed the project description and maps submitted by RJG &A and responded
(04 Nov 2014 attached) that the project construction area is unlikely to have any significant archaeological resources, and that an
archaeological survey is not needed Four historic sites listed in the National Register of Historic Places occur along NC -62 and
could be affected by raw water line construction William Poteat House (CS0013), Melrose (Williamson) House (CS0070), Lea's
Tavern (CS0077), and NC -62 Rural Historic District (CS0074) SHPO requested detailed mapping of the waterline construction
corridor for their use in determining potential effects of the project In an email response to SHPO, RJG &A explained that detailed
plans for the raw water line would not be prepared for at least 5 years, and the applicant would need to coordinate again with SHPO
at that time
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA - designated 100 -year floodplam?
® Yes ❑ No
8b If yes, explain how project meets FEMA requirements
The intake channel excavation will create a net increase in flood storage capacity within the Dan River floodway and will not
cause any rise in flood elevations upstream or downstream A small area of floodplam in the ravine will be raised slightly for
the pump station pad, but this minor fill will be offset by more than 50 times more cut volume
8c What source(s) did you use to make the floodplam determination? Caswell County FIRM Panel 49031 (viewed on
ncfloodmaps com and frrs nc gov) 100 -yr flood hazard elevation (zone AE) is 379 8 feet at the intake site, and 379 5 feet on the
tributary downstream of the intake access road crossing There is no other FEMA mapped floodplam along the remainder of
the raw water line corridor to the Yanceyville WTP
Page 12 of 14
PCN Form — Version 1 3, Dec 2008

Gerald B Pottern 22 November 2014
Applicant/ Agent's Printed Name Applicant or Agent's Signature Date
(Agent's signature is valid only if authorization letter from applicant is provided )
ATTACHMENTS
Stormwater calculations table from Erosion & Sedimentation Control Plan
Figure 1 Project vicinity, USGS topographic map, Milton NC quad
Figure 2 Dan River intake site property survey plat, 2003
Figure 3 Caswell County GIS tax map, adjacent properties
Figure 4 Google Earth aerial photo of Dan River intake site property
Figure 5 Dan River intake site grading plan, overview map
Figure 6 Impact WI Wetland YG in footprint of proposed intake channel
Figure 7 Impact SI Stream 1, proposed intake access road crossing
Figure 8 Impact 01 Dan River cofferdam, bank excavation, and armoring
Figure 9 Cofferdam and dewatering process, cross - section
Figure 10 A -D Dan River intake site erosion control & grading plan, close -ups
Figure 11 A -D USGS topo maps of raw water line, stream and wetland crossings
Agent Authorization from Property Owner
SHPO Project Review Letter, 04 Nov 2014
NC -DLQ Erosion & Sedimentation Plan Approval
Stream Quality Assessment Form
Wetland Determination Data Forms
Preliminary JD Request Form
Page 13 of 14
PCN Form — Version 1 3, Dec 2008

P-,
wti
Page 14 of 14
PCN Form — Version 1 3, Dec 2008
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PCN Form — Version 1 3, Dec 2008

IMP
Figure 2. Dan River intake site property survey plat, 2003, Caswell County NC.
Figures for PCN Application: Dan River Intake, Caswell County NC
RJG &A Environmental Consultants — November 2014 1
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try _
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f
ti/
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axfe
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Intake Site
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iV
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4
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Figure 2. Dan River intake site property survey plat, 2003, Caswell County NC.
Figures for PCN Application: Dan River Intake, Caswell County NC
RJG &A Environmental Consultants — November 2014 1

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\ t
/�V tvc00�A9
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PIN 0106.0000.0134
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Caswell County GIS
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t
tf
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acres = 24.2
Town of Yanceyvill¢�
PIN 0106 0000 0142
acres =1625 MILT7N "'Y +4
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+- 1013330, E; 1931240
1.11 36°32' 01.9'. Ln -. ? � - +
Figure 3. Caswell County GIS Tax Map, adjacent properties.
Figure 4. Dan River Intake site, Google Earth Aerial Image, Apr 2014, Caswell
2

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Borrow & k'
Fill Area ;
Figures for PCN Application: Dan River Intake, Caswell County NC
RJG &A Environmental Consultants — November 2014 3

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0
Figure 6. Wetland impact W -1: Wetland YG (isolated, in footprint of proposed intake channel).
t Intermittent Stream Impact S -1 j i
102 lin. feet culvert +headwalls *�+
/ 46 fin. feet riprap aprons + i
Oe
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Figure 6. Wetland impact W -1: Wetland YG (isolated, in footprint of proposed intake channel).
t Intermittent Stream Impact S -1 j i
102 lin. feet culvert +headwalls *�+
/ 46 fin. feet riprap aprons + i
Oe
/ j �° / /' j° f / j• / 17
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/
i f /' i SO feet,
i I t ! ! i i l i i 1 1 i i"! i 1+ 11,iYd/ lI / I/
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Figure 7. Stream Impact S -1: Intake access road crossing culvert and riprap.
11
tt+
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Figure 7. Stream Impact S -1: Intake access road crossing culvert and riprap.
11

fMRALjr,R T4 WSTML A FEW' RWY
CJ"MAV AW/rA A .OtSEY ft" G
SYSTEM PITH ?A _ WHLE THE LAST PHASE
6i t�C ­A11m Of T4 RvaWAL
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Impact Area 0-1
Dan River Intake
Vii..: i!�� /.'.1�- •, s 1 /� / / { / /! / //�
NN N
et/ 0 1
mov
so feet Exr v,
Figure 8. River bank open water impacts, Dan River intake.
CONTRACTOR TO INSTALL A TEMPORARY
COFFERDAM AND A JERSEY BARRIER DETAIL OF COFFERDAM BARRIER AT DAN RIVER
MATH PUr
SYSTEM PS WHILE THE LAST PHASE
OF EXCAVATION OF THE TRAPEZOIDAL
CHANNEL IS PERFORMED TO TIE —INTO THE PVW ANY SEDIMENT LAM WATER
DAN RIVER TO SILT SM OR OTHER
pDLyErW_WpLASTIC APPROPFARTE FILTERING DEVICES
BARRIER
SLTSACK
CONCRETE JERSEY BARKER EMSTING
X7 CWX SA10
DAN RIVER NORMAL DEPTH
DISCtOA GE OF FLTEMD
SLRGE STONE LEVE ING
CLEAN FIUWF
_a0LASE CLASS I RP UP AS
NECESSARY
"GE STOW
EXITING PAT: R 8 0 T T DONt
&W PLWS AS
NECESSARY
STON
1. ENSURE CONCRETE JERSEY BARRIERS ARE ADEQUATELY ANCHORED
TOGETHER (END TO END) FOR STABILITY.
2. CONTRACTOR TO FREQUENTLY CHECK THE BARRIERS TO ENSURE
THE STRUCTURES ARE PLUMB. ADD RIP RAP AND RESET BARRIERS
AS NECESSARY.
3. ADD POLYETHYLENE PLASTIC BARRIER AND ADDITIONAL SUMP / //i
PUMP(S) AS NECESSARY TO KEEP THE TRAPEZOIDAL OPEN CHANNEL
TIE-IN TO THE DAN RIVER AS DRY AS POSSIBLE DURING GRADING
AND PLACING OF THE ARMORFLEX ARTICULATED CONCRETE BLOCK
UNITS.
4. PUMP ANY SEDIMENT LADEN WATER THAT IS IN THE EXCAVATION
AREA TO SILT SACKS OR OTHER APPROPRIATE FILTERING DEVICES.
Figure 9. Cofferdam and dewatering process, cross-section at river bank.
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AGENT AUTHORIZATION FORM for Environmental Permitting
PROPERTY LEGAL DESCRIPTION: Town of Yanceyville Dan River Intake Site
LOT NO. PLAN NO. PARCEL ID: PIN # 0106 0000 0142
STREET ADDRESS- NC- Highway 62, Milton NC
Please print:
Property Owner 1: Town of Yanceyville, do Brian Collie, town manager
Property Owner 2:
The undersigned, registered property owners of the above noted property, do hereby authorize
Gerald Pottern of Robert J. Goldstein & Associates Inc (RJG&A)
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this
permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above) -
Town Manager, PO Box 727, Yanceyville NC 27379
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge.
,&44
Authorized Signature i
Authorized Signature 2
Date: // /I- i L Date:

is SrAT1: w
Gwen
North Carolina Department of Cultural Resources
State Historic Preservation Office
Ramona n1 Barto,, Adirum.trator
GoN ernor Pat McCrory Office of Archn eti and I fistory
Secretary Susan Klutti Deputy Secretary KLX in Cherry
November 4, 2014
Gerald Pottern gpottern@RJGAcarohna com
RJG&A Goldstein & Associates, Inc
1221 Corporation Parkway, Suite 100
Raleigh, NC 27610
Re Dan River Water Intake & Raw Water Transmission Lines, Caswell County, ER 14 -2481
Dear Mr Pottern
We are in receipt of your letter of October 21, 2014, concerning the above - referenced undertaking We have
reviewed the materials submitted and offer the following comments
There are no known archaeological sites within the proposed project area Based on our knowledge of the
area, it is unlikely that any archaeological resources that may be eligible for inclusion in the National Register of
Historic Places will be affected by the project We, therefore, recommend that no archaeological investigation
be conducted in connection with this project
We reviewed the project description and maps of the project area According to the HPOGIS website
http / /g_is ncdcr gov /hpoweb/ the proposed undertaking may affect the following National Register -listed
properties
• Poteat House (CS0013)
• Melrose (Williamson) House (CS0070)
The following Study -listed properties are considered eligible for inclusion in the National Register of Historic
Places and also may be affected by the installation of a raw water line along NC 62
• Lea's Tavern (CS0077)
• NC 62 Rural Historic District (CS0074)
We understand the raw water line will be buried along NC 62 However, it is unclear if the proposed work will
be performed within existing DOT Right -of -Ways and where the work will occur in relation to the
aforementioned properties
To assist us with making a determination regarding the potential effects of the project, we request you provide
maps that clearly illustrate the proposed location for the raw water line in reference to historic resources using
the HPOGIS website
Location 109 L1u Jones Street, Italeigh NC 27601 Mailing Address 4617 Nl id Scn ice Center, Rilcigh NC 27699 -4617 Telephone /Fax (919) 807 - 6570/807 -6599

To obtain shapefiles of our HPO GIS data, please visit the Data Download webpage at
http / /w-,vw hpo ncdcr.gov/gis/CountyDisclaimers html #DataDownload There you will find a zipped file
that contains shapefiles for everything you see in HPOWEB and a thorough description regarding the colors
and shapes in our symbology Please feel free to contact us with any questions you may have regarding the
HPOGIS website and the HPO GIS data
The above comments are made pursuant to Section 106 of the National Historic Preservation Act and the
Advisory Council on Historic Preservation's Regulations for Compliance with Section 106 codified at 36 CFR
Part 800
Thank you for your cooperation and consideration If you have questions concerning the above comment,
contact Renee Gledhill- Earley, environmental review coordinator, at 919- 807 -6579 or
environmental review(@ncdcr gov In all future communication concerning this pro)ect, please cite the above
referenced tracking number
Sincerely,
s
.,'Ramona M Bartos
f

North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Land Quality Section
Tracy E Davis, PE, CPM Pat McCrory, Governor
Director John E Skvarla, III, Secretary
June 06, 2014
LETTER OF APPROVAL
City of Roxboro
ATTN- Tommy Warren
PO Box 128
Roxboro, NC 27573
RE: Project Name- Roxboro Raw Water Intake
Project ID CASWE- 2014 -005 Acres Approved 11 00
County Caswell, Highway 62, Milton
River Basin Roanoke Stream Classification Other
Submitted By Paul Stimpson, Pease Engineering and Architecture PC
Date Received by LQS May 30, 2014
Plan Type Revised
Dear Mr Warren.
This office has reviewed tltc sublcct erosion and sedimentation control plan We find the plan to be
acceptable and hereby issue tilts L,ettei of Approval The enclosed Ceitificate of Appi oval must be
posted at the job site lhis plan approval sliall exptie three (3) yeais following the date of approval,
if no land - disturbing activity has been undcitaken, as is required by Title 15A NCAC 413 0129.
Please be aware that your project will be covered by the enclosed NPDES Construction Stormwater
General Permit NCG010000 Please become familiar with all the requirements and conditions of
this permit in order to achieve compliance
Title 15A NCAC 413 01 18(a) tequires that a copy of the approved erosion control plan be on file at
thejob site Also, this letter gives the notice: tegtnred by G S 113A -61 1(a) of our right of periodic
inspection to i nsute compliance with the approved plan
Winston -Salem Regional Office
585 Waughtown Street, Winston - Salem, North Carolina 27107 Phone [phone] Fax [phone]

Letter of Approval
Project• Roxboro Raw Water Intake
June 06, 2014
Page 2 of 2
North Caiohnas Sedimentation Pollution Control Act is peifoiinance- oriented, requiring piotection
of existing natuia] resouices and adjoining propeities. If, folloiN ing the conunnencement of this
piojeet it is determined that the e.►os►on and sedimentation control plan is inadequate to meet the
icquirements of the Sedimentation Pollution Control Act of 1973 (North Carolina General Statute
113A -51 through 66), this office may require revisions to the plan and implementation of the
revisions to insure compliance with the Act
Acceptance and app ►oval of this plan is conditioned upon your compliance with Federal and State
water quality Naiws, regulations and rules In addition, local city or county ordinances o► ►tiles may
also apply to this land - disturbing activity This approval does not supci scde any €ithcr perinnrt or
approval.
Please note that this approval is based in part on the accuracy of the information provided in the
Financial Responsibility Dorm, which you provided You are requested to file an amended form if
there is puny change in the information included on the form In addition, it would be helpful if you
notify this office of the proposed starting date for this project. Please notify us if you plan to have a
preconstruction conference
Your cooperation is appreciated
Sincerely,
Sue White
Regional Engineer
Land Quality Section
Enclosures- Certificate of Approval
NPDES Permit
cc. Paul Stimpson, Pease Engineering and Architecture PC
121 West Innes Street, Suite B, Salisbury, NC 28144

USACE AID# DWQ # Site # Str -1 (indicate on attached map)
Project Yanceyville Dan River intake, Caswell County
;,m„ STREAM QUALITY ASSESSMENT WORKSHEET AQ
Provide the following information for the stream reach under assessment.
I Applicant's name Tommy Warren, City Manager 2. Evaluator's name Gerald Pottern — R J Goldstein & Assoc
3 Date of evaluation October 28, 2014 4 Time of evaluation 3 00 pm
5 Name of stream UT Dan River 6 River basin Dan River (Roanoke)
7 Approximate drainage area 33 acres, 0 05 sq mi _ 8 Stream order
9 Length of reach evaluated 300 ft 10 County Caswell
I 1 Site coordinates (if known) prefer in decimal degrees 12. Subdivision name (if any)
Latitude (ex 34 872312) 365320 Longitude (ex —77 55661 1) 792178
Method location determined (circle) GPS Topo Sheet Ortho (Aerial) Photo /GIS Other GIS Other Google Earth
13 Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location)
North- flowine tributary alone east edee of proposed Dan River intake property, l mile S of Milton NC
14 Proposed channel work (if any) install 102 ft concrete culvert with headwalls and riprap energy dissipaters at inlet & outlet
15. Recent weather conditions normal, moderate rainfall durine past week
16. Site conditions at time of visit normal base flow, no rain today
17. identify any special waterway classifications known _Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters _Nutrient Sensitive Waters _Water Supply Watershed (I -IV)
18 Is there a pond or lake located upstream of the evaluation point? YES NO If yes, estimate the water surface area 1.0 acre
19 Does channel appear on USGS quad map? YES NO 20. Does channel appear on USDA Soil Survey? YES NO
21 Estimated watershed land use 5 % Residential % Commercial % Industrial 80 % Agricultural
22. Bankfull width 6 to 8 feet
24 Channel slope down center of stream
15 % Forested % Cleared / Logged % Other ( )
Flat (0 to 2 %)
25 Channel sinuosity Straight _Occasional bends
23 Bank height (from bed to top of bank) 2 to 4 feet
Gentle (2 to 4 %) X Moderate (4 to 10 %) _Steep ( >10 %)
X 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
Total Score (from reverse). 66 Comments: Bedrock steps & pools with sand & silt deposits, 2 to 5' wide at low to
normal water elevation Forest buffer 30 to 50 ft wide, cattle pasture beyond buffer Nutrient enriched from pasture runoff
Evaluator's Signature zzy—! � 12 bl , — Date October 29, 2014
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental 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
Prmprt Name_ Cite Niirnhil Ynnirevville Dan River intake. STR-1
* These characteristics are not assessed in coastal streams
RA al AIC10; S�,,
"W4
26 1* ORtGlf0i`l�, ItRXMIG-
h;j
--p-
IkORE,
4 X-C 1 40.
0067iiifa Vo,, wPiedmondi
`Mori to airi`
Preseiiici-,of flow, /,pgsistcnt pools i&stream
5
W`4
0' ' S W
3
0
M W,', max points)
(no, ow or saturation 0, strong flo
F
Aow-
,2�
, M,,_-10idence of past human alteration
zQW
5
R
0 -5
4
Jell
(extensive alteration IT'O, no alteration T,-,-'max points)
3
Iqu = Riparian i(;47e� I TT
�0_ 6-
R
-0=4
0 - 5-,�
3
(no,buffer -,O,-conti ous, wide buffer S)
& max point'
Evidence of nutrient orchemicalAisa6ijes
Is",%4
-4
'A," prv­­
-V40 - 5
J411Ws
M 0- 4/
3
extensive disAMM 0,'db di§chardsF7- maxl�)rmts)
6
_41 'IVI-4-Groundwater dischargil
11
VW__
jh"argil &il
_,2�_
0-73
4,,
I "WIM
0-2
1---.2-YE�
3
(nol C 10 Ispringsmseeps, WetlanR mA points)
14&p -ak
6
__1 "! _­M_ ._­__V­__ 11 I—
P Presence of Idiacefit -floodp
, � " 6 (, 7
no,fl&6dplani'," E,O,,extensive flood lam max points)
-
A
3-r -4
0 ='2-
2
51,7
eggwvk
tn'ifinchmen f ess
1k, tF/-flo--6d6`la in`a,,Zffi=,TA_
A-1411(deeplyrditfenched
9,*---0 5
X7, 0, 4
0,1,
-�2
2
max points--"
7,
�'111
8--
2L
Pre'ose�nK�cw�A!.,adjacentIO4-4�laifid
-4, 'A s
1C,
Vo
M no wetlands ril '�` ints),-,
0-6
-�NCL
--
0 -4
0-2
w"�
0
41
-7- Cha`H`neF_sm`u`osity
0
0 �,"41'
0
3
AN
Rtensive channeliza-tibb-= 0, naturaliffil max points)
sediment input`' Wim _5101
tensive° deposition-- 03littl6 onrib'sediniffitil max �oints)
We
0",7;
0 24i6
F-
2
lv�ersit)�of N ,,Size channel bed,substrate
'1(fine,
N
%Aa�
0
2
6moge�a - 0,4" rse siAe"FUWApoin
N, ts) a
W R� . arge,'di��
%.`� K_
L_
12
'Rwvi di-nce'of'cJiannel milion o"r"W'idening,
�1 *F - :ncise'Wd-rj_L0,
0 7-4, -!,Jll
0,15%11j�
4
(d eke4p I y si�8le'b'Jd%kibanks ��-`%iax points)
frris'i�&N;f major Wq�Wfiilures
A L
mazy erosion' �0, n6,er6sion, stabl&& anks ma- oints)
$0- 5
"V�' 4�'&
0
W 5-
4
Root depth and d4sit`y %n 6anks
VA -
'n
ffil
4 M"
1
04,4,,:,Aft
4
no Visible rootg�
J�0, den§e�rootslltlroughclu&N,� max
-.R� ,
W
466sta
Ml
rA
Impact ,16y agriculture, Or timber prbTuction
j ,; substantial impact =0, no evidence =111inax poin
5 E E,
0 4
"
IN
3
N
M
6
14R�� P'"s Mlfiomplex'es� "'3
kire7deibf,iiffli�pool/ripi
7
X
0-3
� 0-5
0 - 6
4
no riffleVripples or - 0, well-"developed max,points)
W
Habitat complexity
(little or- habitat 0; -ire went, VNP&6d habitats L'Mk points)&
0 6";�­,
fi�
«
nV*ffi_xl
Canopy Coverage-over'streambed -SW
7 adilnLg vegetation 0,�,cofitinuous canopy max�ppirl
- '(no sh
5�-0 -5
0-5,
5
tr
0,
'219
S, Is
S ii b git"fev6piweid 7ediil W
4--%"0qqL, &M w
tt
AM
,J
m
- 0'-T
p
=- 0&-
,,0-4
3
,embedded 0,-loose` structure mix-)
71
0-
y-
Presence am e rates (se6'page.,_
P 'Ustre
W I 4
0 5-
0 �,�5,;q,
3
>-(
�1
E,
C(no evidence mAM, s type"s=',��mts
om
0
-
-,*-,
21-
f a-
"JXv&9' Vresencil mphibians 41
0` 4
%k,&, 0 -4
0 -,4 ,
2
f
0
_Z-,��
7
-A(ifo evidence 0, common, nutil types'= maxipoints)
2T,
V1"i� PrWince of nili"
14, f
WC - 4
DRIF
0-�4
0
0*
�'W(Aoo evidence 0, numerous types maC'� oint,,
common,
23 J
L
JEW& iice of wildlife� Z
i useik
�--QAXF ------ --A�
wey�idence
AA 26
0 5
S
3
*d rnA
NM no 6Tabu_nlwan�t evidence ffiak4p61nts) I
10MAN'17
lTdnts P@S'sible
Td a
0
W3 - P7, 1 113
-TO AL SCO RE RE (Al! ?Mnt ei4l @ g e)
NM
66
, WSKr;Zs�ti,p =
* These characteristics are not assessed in coastal streams

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region YG -wet
Project/Site Dan River Intake City /County Milton, Caswell County Sampling Date 28 Oct 201
Applicant/Owner City of Roxboro & Town of Yanceyville State NC Sampling Point YG -3 wet
Investigator(s) Gerald Pottern, RJG &A Enviro Consult Section, Township, Range
Landform (hillslope, terrace etc ) floodplain terrace Local relief (concave, convex, none) concave, FP depression Slope ( %) 0 -2
Subregion (LRR or MLRA) P -136 Lat 36 5332 Long 792194 Datum NAD -83
Soil Map Unit Name (no soil mapping in Caswell Co) NWI classification PF01A
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 no significantly disturbed? Are "Normal Circumstances" present? Yes X No
Are Vegetation , Soil , or Hydrology no 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
Wetland flags YG -1 through YG -12 in Isolated wetland depression In ravine SE of old railroad embankment Drains Into
culvert at flag YG -8 Flags YG -13 to YG -15 along 4 -6 ft wide linear wetland beginning at culvert outlet, NW of railroad
embankment, dissipates Into non - hydric soil 45 ft beyond culvert outlet No surface connection to Dan River
HYDROLOGY
Wetland Hydrology Indicators
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required, check all that apply) _ Surface Soil Cracks (66)
• Surface Water (Al)
_ True Aquatic Plants (B14) _ Sparsely Vegetated Concave Surface (68)
• High Water Table (A2)
_ Hydrogen Sulfide Odor (Cl) — Drainage Patterns (1310)
• Saturation (A3)
_ Oxidized Rhizospheres on Living Roots (C3) _ Moss Trim Lines (616)
_ Water Marks (131)
_ Presence of Reduced Iron (C4) _ Dry- Season Water Table (C2)
Sediment Deposits (82)
_ Recent Iron Reduction in Tilled Soils (C6) _ Crayfish Burrows (C8)
x Drift Deposits (63)
_ Thin Muck Surface (C7) _ Saturation Visible on Aerial Imagery (C9)
_ Algal Mat or Crust (64)
_ Other (Explain in Remarks) _ Stunted or Stressed Plants (D1)
_ Iron Deposits (65)
_ Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (67)
_ Shallow Aquitard (D3)
x Water- Stained Leaves (B9)
_ Microtopographic Relief (D4)
Aquatic Fauna (613)
_ FAC- Neutral Test (D5)
Field Observations
Surface Water Present? Yes x No
Depth (inches) 1
Water Table Present? Yes x No
Depth (inches) 0 -12
Saturation Present? Yes x No
Depth (inches) 0 -6
Wetland Hydrology Present? Yes x No
includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available
Remarks
Wetland hydrology probably enhanced
or created by ponding In ravine due to railroad embankment
Wetland outflow dissipates Into non - hydric soils beyond the outlet of the culvert under the railroad
embankment
US Army Corps of Engineers Eastern Mountains and Piedmont – Version 2 0

VEGETATION (Four Strata) — Use scientific names of plants
Sampling Point YG -3 wet
Remarks (Include photo numbers here or on a separate sheet )
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2 0
Absolute
Dominant Indicator
Dominance Test worksheet
Tree Stratum (Plot size 30 ft diam )
% Cover
Species? Status
Number of Dominant Species
1
Liquidambar styraciflua
15
y fac
That Are OBL, FACW, or FAC 8 (A)
2
Linodendron tulipifera
12
y facu
3
Carpinus caroliniana
15
y fac
Total Number of Dominant 9
Species Across All Strata (B)
4
Acer rubrum
12
y fac
8
Percent of Dominant Species
5
Quercus schumardn
n
That Are OBL, FACW, or FAC 89% (A/B)
6
Celtis laevigata
10
n
Prevalence Index worksheet
7
Total % Cover of Multiply by
8
72
= Total Cover
OBL species x 1 =
Sapling /Shrub Stratum (Plot size 30 ft dram
)
FACW species x 2 =
1
Liquidambar styraaflua
20
y fac
FAC species x 3 =
2
Carpinus caroliniana
20
y fac
FACU species x 4 =
3
Fraxinus pennsylvanica
15
n
UPL species x 5 =
4
Asimina tnloba
10
n
Column Totals (A) (B)
5
Platanus occidentalis
15
n
Prevalence Index = B/A =
6
Hydrophytic Vegetation Indicators
7
_ 1 -Rapid Test for Hydrophytic Vegetation
8
x_ 2 - Dominance Test is >50%
9
_ 3 - Prevalence Index is :53 0'
10
4 - Morphological Adaptations' (Provide supporting
80
= Total Cover
_
Herb
Stratum (Plot size 30 ft diam )
data in Remarks or on a separate sheet)
Asimina triloba
15
y fac
Problematic Hydrophytic Vegetation' (Explain)
1
_
2
Lomcera japonica
10
y fac
3
Polystichum acrostichoides
5
n
'Indicators of hydnc sod and wetland hydrology must
Eurybia divaricata / cordifolia ?
5
n
be present, unless disturbed or problematic
4
Definitions of Four Vegetation Strata
5
6
Tree — Woody plants, excluding vines, 3 in (7 6 cm) or
more in diameter at breast height (DBH), regardless of
7
height
8
Sapling /Shrub — Woody plants, excluding vines, less
9
than 3 in DBH and greater than or equal to 3 28 ft (1
10
m) tall
11
Herb —All herbaceous (non- woody) plants, regardless
12
of size, and woody plants less than 3 28 ft tall
35
= Total Cover
Woody Vine Stratum (Plot size )
Woody vine — All woody vines greater than 3 28 ft in
1
Vitis rotundifolia
10
y fac
height
2
3
4
Hydrophytic
5
Vegetation
6
Present? Yes x No
10
= Total Cover
Remarks (Include photo numbers here or on a separate sheet )
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2 0

SOIL Sampling Point YG -3 wet
Profile Description (Describe to the depth needed to document the indicator or confirm the absence of indicators)
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Lo Texture Texture Remarks
0 -5 10 YR 2/2 100 loam
5 -20 10 YR 2/1 90 10 YR 4/4 10 C m loam
'Type C= Concentration, D= Depletion, RM= Reduced Matrix. MS= Masked Sand Grains
Hydnc Soil Indicators
Histosol (Al)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
_ Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
_ Depleted Below Dark Surface (A11)
_ Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
_ Sandy Gleyed Matrix (S4)
Sandy Redox (S5)
_ Stripped Matrix (S6)
Restrictive Layer (if observed)
Type
Depth (inches)
Remarks
2Location PL =Pore Lining, M =Matrix
Indicators for Problematic Hydnc Sc
_ Dark Surface (S7)
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
x Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron- Manganese Masses (F12) (LRR N,
MLRA 136)
Umbric Surface (F13) (MLRA 136, 122)
x_ Piedmont Floodplain Sods (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 147)
2 cm Muck (A10) (MLRA 147)
Coast Prairie Redox (A16)
(MLRA 147, 148)
_ Piedmont Floodplam Soils (F19)
(MLRA 136, 147)
Very Shallow Dark Surface (TF12)
Other (Explain in Remarks)
3Indicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic
Hydnc Soil Present? Yes X No
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2 0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project /Site Dan River Intake City /County Milton, Caswell County Sampling Date
Applicant /Owner City of Roxboro & Town of Yanceyville
State NC Sampling Poin
t
YG -u pl
28 Oct 20141
YG u pl
Investigator(s) Gerald Pottem, RJG &A Enviro Consult Section, Township, Range
Landform (hillslope, terrace, etc ) floodplain terrace Local relief (concave, convex, none) slope N of depression Slope ( %) 2
Subregion (LRR or MLRA) P -136 Let 36 5334 Long 792193 Datum NAD -83
Sal Map Unit Name (no soil mapping in Caswell Co) NWI classification
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 no significantly disturbed? Are "Normal Circumstances" present? Yes X No
Are Vegetation Soil or Hydrology no 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 Sal Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks
Wetland flags YG -1 through YG -12 In Isolated wetland depression In ravine SE of old railroad embankment Drains Into
culvert at flag YG -8 Flags YG -13 to YG -15 along 4 -6 ft wide Ilnezy wetland beginning at culvert outlet, NW of railroad
embankment, dissipates Into non - hydric soil 45 ft beyond culvert outlet No surface connection to Dan River
HYDROLOGY
Wetland Hydrology Indicators
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required check all that apply) _ Surface Sal Cracks (136)
_ Surface Water (A1) _
True Aquatic Plants (614) _ Sparsely Vegetated Concave Surface (68)
_ High Water Table (A2) _
Hydrogen Sulfide Odor (Cl) _ Drainage Patterns (610)
_ Saturation (A3) _
Oxidized Rhizospheres on Living Roots (C3) _ Moss Trim Lines (1316)
_ Water Marks (Bi) _
Presence of Reduced Iron (C4) _ Dry- Season Water Table (C2)
_ Sediment Deposits (62) _
Recent Iron Reduction in Tilled Soils (C6) _ Crayfish Burrows (C8)
_ Drift Deposits (B3) _
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 (65)
_ Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (87)
_ Shallow Aquitard (D3)
_ Water- Stained Leaves (B9)
_ Microtopographic Relief (D4)
_ Aquatic Fauna (613)
_ FAC- Neutral Test (D5)
Field Observations
Surface Water Present? Yes No X
Depth (inches)
Water Table Present? Yes No X
Depth (inches)
Saturation Present? Yes No X
Depth (inches) > 12„
Wetland Hydrology Present? Yes No X
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring
well, aerial photos previous inspections), if available
Remarks
Wetland hydrology probably enhanced or created by ponding In ravine due to railroad embankment
Wetland outflow dissipates into non- hydrlc soils beyond the outlet of the culvert under the railroad
embankment
US Army Corps of Engineers Eastern Mountains and Piedmont —Version 2 0

VEGETATION (Four Strata) — Use scientific names of plants
Sampling Point YG upl
Remarks (Include photo numbers here or on a separate sheet )
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2 0
Absolute
Dominant Indicator
Dominance Test worksheet
Tree Stratum (Plot size 30 ft dram )
% Cover
Species?
Status
Number of Dominant Species
1
Celtis laevigata
10
n
That Are OBL, FACW, or FAC 8 (A)
2
Linodendron tulipifera
20
y
face
Total Number of Dominant
3
Carpinus caroliniana
15
y
fac
9
Species Across All Strata (B)
q
Fraxinus pennsylvanica
15
y
faces
5
Paulawnia tomentosai
10
n
Percent of Dominant Species
89% �0
That Are OBL, FACW, or FAC (A/B)
6
Platanus occidentals
10
n
Prevalence Index worksheet
7
Total % Cover of Multiply by
8
80
= Total Cover
OBL species x 1 =
Sapling /Shrub Stratum (Plot size 30 ft diam
)
FACW species x 2 =
1
Liquidambar styraciflua
20
y
fac
FAC species x 3 =
2
Carpinus caroliniana
20
y
fac
FACU species x 4 =
3
Lindera benzoib
10
n
UPL species x 5 =
q
Asimina triloba
10
n
Column Totals (A) (B)
5
Prevalence Index = B/A =
6
Hydrophytic Vegetation Indicators
7
1 - Rapid Test for Hydrophytic Vegetation
8
_
X 2 - Dominance Test is >50%
9
3 - Prevalence Index is 53 0'
10
4 - Morphological Adaptations' (Provide supporting
60
= Total Cover
_
Herb Stratum (Plot size 30 ft diam )
data in Remarks or on a separate sheet)
1
Asimina tnloba
15
y
fac
Problematic Hydrophytic Vegetation' (Explain)
2
Lonicera japonica
10
y
fac
3
Polystichum acrostichoides
5
n
'Indicators of hydnc soil and wetland hydrology must
q
Toxicodendren radicans
10
y
fac
be present, unless disturbed or problematic
Definitions of Four Vegetation Strata
5
6
Tree — Woody plants, excluding vines, 3 in (7 6 cm) or
7
more in diameter at breast height (DBH), regardless of
height
8
9
Sapling/Shrub —Woody plants excluding vines, less
than 3 in DBH and greater than or equal to 3 28 ft (1
10
m) tall
11
Herb —AII herbaceous (non- woody) plants regardless
12
of size and woody plants less than 3 28 ft tall
40
= Total Cover
Woody Vine Stratum (Plot size )
Woody vine — All woody vines greater than 3 28 It in
1
Vitis rotundifolia
10
y
fac
height
2
Bignonia capreolata
5
n
3
4
5
Hydrophytic
Vegetation
6
Present? Yes x No
15
= Total Cover
Remarks (Include photo numbers here or on a separate sheet )
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2 0

SOIL
Sampling Point YG upl
Profile Description (Describe to the depth needed to document the indicator or confirm the absence of indicators
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Loc2 Texture Remarks
0 -6 10 YR 4/4 100 sand loam
6 -18 10 YR 5/6 100 clay loam
'Type C= Concentration, D= Depletion, RM =Red
Hydnc Soil Indicators
_ Histosol (Al)
Histic Epipedon (A2)
_ Black Histic (A3)
_ Hydrogen Sulfide (A4)
Stratified Layers (A5)
_ 2 cm Muck (A10) (LRR N)
_ Depleted Below Dark Surface (A11)
_ Thick Dark Surface (Al2)
_ Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
_ Sandy Gleyed Matrix (S4)
_ Sandy Redox (S5)
_ Stripped Matrix (S6)
Restrictive Layer (if observed)
Type
Depth (inches)
MS= Masked Sand Grains 2Location PL =Pore Lining, M= Matrix
Indicators for Problematic Hydnc So
Dark Surface (S7)
_ 2 cm Muck (A10) (MLRA 147)
_ Polyvalue Below Surface (S8) (MLRA 147, 148)
_ Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
(MLRA 147, 148)
Loamy Gleyed Matrix (F2)
_ Piedmont Floodplain Soils (F19)
Depleted Matrix (F3)
(MLRA 136, 147)
_ Redox Dark Surface (F6)
_ Very Shallow Dark Surface (TF12)
Depleted Dark Surface (F7)
_ Other (Explain in Remarks)
Redox Depressions (F8)
Iron- Manganese Masses (F12) (LRR N,
MLRA 136)
_ Umbnc Surface (F13) (MLRA 136, 122) 3Indicators of hydrophytic vegetation and
Piedmont Floodplain Soils (F19) (MLRA 148) wetland hydrology must be present
Red Parent Material (F21) (MLRA 127, 147) unless disturbed or problematic
Hydnc Soil Present? Yes No X
UPL sample on low -slope terrace - 2 ft elev above wetland YG
US Army Corps of Engineers Eastern Mountains and Piedmont —Version 2 0

Jurisdictional Determination Request
A, P A RCI - 1. 1 N F() R iN I Al 10 N
Street Addr-.3s Benincincuseal 11217NC 1-1VOY62N,-MILTON NOF s
City, State: M A ryi, NC
Comm,
p icipo sW a ocem xia d ts. ju srso utb oljtto h ou of v)b poor--irre.
Parcel Index NUM krI q) (P NW
13 REQUESTOR INFORMATION
Minw: Gefald'PoWnj
n J& A
Weigh NC M16
Tfol -4� n p W.
Malling Address-
Telephone NUM ber 919-872-1174
I-- I e ctron ic Nit aj I A ddre,;,; G P or ft ---- r n g R J GA c a, o r V3 z 0M
S e I I-C t one;
I wTi the turi-crit pr0pertN^ 0%,,nCr
I am an Authorized Agent or Frivirotirmntal COW3U]tatit'
Interested Buyer or Under Contract to PUrchase
Other, pleuse explain
1110 P-LIZ I Y OWN LIZ IN FOWNI A'I ION
N rrie, Brian poi e, ia,6ey,
'ti3.Tow, #Aaner 6e�r
Mailim-TAddress PO Box727 Yano NC 2� n
YaoxyVik.
1'elephow Number 334i4-5431
rn 4�0
a
I-Awronit. Nfail Addrcs,,' tc�,v'� aT14, 41ce imqjc,�
MProof of Owrierqhip Anached (c g. a copy of Deed, COUnry G1S,1ParM,-Ta\ Record data)
If avai la ble
must attach completed Agent Authorization Form
If available
Version December 2.013 Page 3

Jurisdictional Determination Request
D. PROPERTY OWNER CEIMFICATION4
I the Linde► signed a (lu1) authotv_ed o"mc► of tecoid of the propeit)'p►ope►t►es identified he►e►n
do authoi►LC ►ep►csentaUves of the \\ tlmmgtorl Disttict. t? S Aim,v Coips ofEngmee►s (Corps)
to enter upon the piopert) heiem described fo► the pu►pose of conducting on -site ►mesttgat►ons
died Issuing,, a dete►mmation associated with Wateis ofthe U S subject to Federal Juusdlction
Wider Section 404 of the Clean Wate► Act andloi Section 10 of the Rivers and I1mbois Act of
1899
Iwo A Lice v -0 c/o
Property Owne► please punt) Date
13,e "* "-
Prope►t} Ovvnei S►gnatuie
E. JURISDICI IONAL DETERMINATION TYPO
Select one
I am icgtlCStut�" that the Cops ptov ide a mchnimmN JD for the ptopett) identified he►em
This request does include a delineation
I am tegtiest►n <o that the Corps piov Ide a p►el ►minaty JD fo► the piopeity identified heiem
This request does NOT Include a delineation
I am requestm�, that the Cups m�e�t►gate the propCit%Ip►olect area for the presence of
absence of \VoUS' and piovtde an appim ed JD fo► the piopeit� identified tie►ein This
request does NO h include a request for a \ e►ified delmeation
I am requesting that the Corps delineate the boundaues at all WoUS on a piopetty /protect
a►ea and provide art apmov ed JD (this may of max not include a sinvet plat)
I am tequesUng that the Cotps evaluate and appiove a delineation of \V'oUS (conducted
bN othets) on a ptopeitv,piolect atea and pim ide an appioved JD (ma} of may not
include a sm vet plat)
' For NCDOT requests following the current NCDOT /USACE protocols, skip to Part E
5 Waters of the United States
Version December 2013 Page 4

jurisdictional Determination Request
F. k I .l. R L O I E ST'4
Map ot Property orpProject Area iattacxhedj. This Map MUSt clearly depict the bOUndines,
IV, I of ilic
ami t
Size of Property ter Project Area �2 � T., _. . acre;
I verity that the prop - rty (or protect) bOUndaries have recently been sUrveFted and marked
I yea licensed land surteyrorOR atv otherwise clearly marked or dtsttnguishable.
C.. .11) It Q1,i F S "I S h72t_)NI C 0NSI II "I AN I S (_)1t AC I NC.'1 LS
( t) Preliminary ,ID Regtte,ts.
V+Conpleted rind signed PreliminarN Airisdictional Determination Forni ".
Ada+
A �
Z
T
Project C�oordinaw -s:4�6 53`0 �1 atat�rc�c 9 2178 I onJtUde
Maps tno lard =er than t l x1 RI with Project BOUndary Ch erlay:
V Lame and small scale naps that depict, at mininrtn; struts. intersections, towwns
-Xerial Photography of the projecr area
USGS Topographic Map
Soil SurvQy Nlap
+'' Other slaps, as appropriate to g National Wed and Inveritoryr flap, Proposed Site
Plan, preViouS delineation maps, LIDA naps, I-ELNIA tloodplain neaps)
`'' See Appendix A of this Form From Regulatory Guidance Letter No 0&02, dated June 26, 2008
Vmsion. Docert ber 2013 pag0 5

Jurisdictional Determination Request
Delineation Information fiNhea applicableC:
%Vetlands,
0 \Vetland Data Sheets
101
El
Fk—/]
IN I
t I plan d I Xt ra Sheet
Landscape Photo.-, if taken
TribLittUICS.
W] USACE Asse-ssment Forms
IT] Cither Assewsrnent. I ornis
t "lien uppropriae)
Field Sketch overlain on legible Map that Includes.
■ All aquatic resotirLo (for silcs with multiple rewurtcs, label and IdentifN)
• L catiows of wetland data points andlor tributary asr,-,,sment reacheq
• Locations of photo qtation5
• A ppmxitnate acreage/linear f0A)tagC of aquatic resources
f 2) Approved 11),, indading VerifiLativkn ofa Ddineation
llr(rwo Coordinates Latitude "QZAI-ongitkidt:
Maps trio lamerthwi I I xI 7) faith Project Boundary Overlay.
F-124-1 Large and small scale reaps that depict, at minimum. street,-,, intersections, tovms
[A Aerial Photography Of tfie project area
USGS Topographic Nlap
Soil Skjr%,Q� Map
Othu Nlaps,ts appropriatc (e g Nlafional Wetland Inventory Map, Proposed Site Plan,
pre% IOL19 delineation raps)
7 1987 Manua I Regional Supplements and Data forms can be found at
Mtn /rojww ima— F.rmv re g m, m a rx
Wetlancd and Strc�arri Assessment Nlethodrflogies can be found at,
httwflnfoital naleni; oiklcyldowinoit hbratwjy�t MC �U LI ki=7bf3c 5bL-d -tb8-41-*jkj, M434 11W fafO6f4c&,qij u old =38jf-4 and
htto 5-vv n =acv« rm, rntl/F DrMT 05,�r M43miRl I-1031,R rdf
Delineation intDi-mation must include at minimum one wetland data sheet for each wetlaridkommunity type
Version. Decerribet 2013 Page 6