20150269 Ver 1_Application_20150313

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STAT� OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
PAT MCCRORY
GovekNOk
February 20, 2015
U.S. Army Corps of Engineers
Wilmington Regulatory Field Office
69 Darlington Ave
Wilmington, North Carolina 28403
ATTN: Ms. Liz Hair
NCDOT Project Manager
Dear Madam:
Subject: Notification for Nationwide Permit 14 (Minor Road Crossing)
NCDENR 401 WQC 3886
Bridge Replacement NC 41 Robeson County
State Project Number: 416651B
Federal Project Number: SF-770446
ANTHONYJ.TATA
SECRETARY
The North Carolina Department of Transportation (NCDOT) proposes to replace an existing
bridge with a culvert on NC 41in Robeson County. The total project length is 0.03miles.
The purpose of the project is to replace an existing Concrete and Timber bridge with an
Aluminum box culvert. The existing bridge has exceeded its life expectancy. The project will
require stream impacts as shown below:
Crossin Roadwa Station Existin Brid e Pro osed Culvert
Permit Site #1 Sta. 13+25 41 LF 21' concrete 76 LF (19' 10"x7'8")
s an. SSLF out to out ACBC w/Headwalls
New Stream Impacts = 76 Zinear feet (42 LF Riv Ran S[one Protection)
Construction of this project will require impacts to wetlands and waters of the United States in
the Lumber River Basin. The waterbody crossed by the structures is Gum Branch (C; Sw). The
project is located within the 03040203 Hydrologic Unit, sub basin 03-07-51.
Permit Site #1 is located at Station 13+25. In 1939 a reinforced, concrete substructure with I-
beams span bridge was built on top of timber caps, end bents and piles. In 1959 the structure
underwent some rehabilitation to the timber portions. Since that time Bridge #446 has served as
a crossing on NC 41 in Lumberton at a location more specifically O.lmi N SR 2415. This bridge
has served its useful life and will be replaced with an Aluminum box culvert. This culvert shall
measure 76 LF (19' 10"x7'8") ACBC. Impacts will include the entire length of this culvert as it
P. O. Box 1150, Fayetteville, NC 28302-1 l50 - Telaphone (9I0) 0.37-0207- Fax (9l0) 486-1959

is replacing a bridge. Also, 10 LF of temporary impacts will be incurred for dewatering purposes
both up and downstream. 20 LF of Class 1 rip rap will be installed upstream and 22 LF
downstream for bank stabilization. Due to the high volume of pedestrian traffic it is necessary to
install a walkway on the upstream side; which will be placed sufficienfly outside of the work
zone. All proper NCDOT BMP's will be utilized during construction.
RESOURCESTATUS
In general, there will be minor impacts proposed as a result of the replacement of the culvert
along NC 41 in Robeson County. A Nationwide Permit #14 / NCDENR 401 WQC 3886 is
required for the project.
Endangered Species: Plants and animals with Federal classification of Endangered (E) or
Threatened (T) are protected under provisions of Section 7 and Section 9 of the Endangered
Species Act of 1973, as amended. As of December 3, 2012, the U.S. Fish and Wildlife Service
lists three (3) federally protected species for Robeson County.
SCIENTIFIC NAME
Alligatar mississippiensis
Rhus michauxii
Protected S ecies for Robeson Coun
COMMON NAME STATUS
woodpecker
American alligator
Michaux's sumac
E
T (S/A)
E
"E" denotes Endangered (a species that is in danger of extinction throughout
al] or a significant portion of its range).
T(S/A)- Threatened due to similariry of appearance, a species that is threatened
Due to similarity of appearance with other rare species and is listed for its
Protection. These species are not biologically endangered or threatened and
Are not subject to SecGon 7 consulbtion.
A biological conclusion of "No EffecY' was reached for all species during the August 16, 2014
survey for protected species. Protected species were not identified, nor, was the general habitaY
for each species identified.

REGULATORY APPROVALS
Application is hereby made for a Department of the Army Nationwide Permit 14 / NCDENR 401
WQC 3886 as required by the above-described activities.
The National Register was reviewed in addition to conducting a field view of the project for
significant historic features.
The project impacts are minor in nature and should not remove ar degrade existing water quality
uses. Pipe sizes proposed are the minimum necessary to create a safe highway while
accommodating the 50-year design storm. There is no record within the NCDOT District 1
Office (Robeson County) that the road experiences flood overtopping. By utilizing the erosion
control measures, downstream water quality standards will be protected. All appropriate BMP's
will be utilized during construction.
Attached is a Preconstruction Notification Form, plan sheets, marked county road map, quad
location map and photographs.
If you should have any questions, or need additional information please contact James J. Rerko,
PWS at [phone].
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ames
ATTACHMENTS
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erko. PWS 3/�3e�-'r
6 Environmental Officer
Cc: Amy Chapman, Division of WaYer Quality (Electronic Copy)
Mason Hendron, Division of Water Quality (Electronic copy)
Greg Burns, P.E., Division Engineer

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. A licant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number: 3856
1c. Has the NWP or GP number been verified by the Corps? � Yes ❑ No
1d. Type(s) of approval sought from the DWQ (check all that apply):
� 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1e. 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.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: NC41, 0.1 mi N SR 2415
2b. County: Robeson County
2c. Nearest municipality / town: Lumberton
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state State Project#: 41665.1 B, Federal Project#: SF-770446
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: NA
3b. Deed Book and Page No. NA
3c. Responsible Party (for LLC if NA
applicable):
3d. Street address: NA
3e. City, state, zip: NA
3f. Telephone no.: NA
3g. Fax no.: NA
3h. Email address: NA
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: � Agent ❑ Other, specify:
4b. Name: Greg Burns, P.E./NCDOT/Div 6/Division Engineer
4c. Business name NCDOT
(if applicable):
4d. Street address: PO Box 1150
4e. City, state, zip: Fayetteville, NC 28302
4f. Telephone no.: [phone]
4g. Fax no.: [phone]
4h. Email address: [e-mail]
5. AgenUConsultant Information (if appficable)
5a. Name: JamesJ. Rerko, PWS
5b. Business name NCDOT/Div 6/Division Environmental Officer
(if applicable):
5c. Street address: PO Box 1150
5d. City, state, zip: Fayetteville, NC 28302
5e. Telephone no.: [phone]
5f. Fax no.: [phone]
5g. Email address: [e-mail]
Paye 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): NA
Latitude: Longitude: -
1b. Site coordinates (in decimal degrees): PS#1: 34.6077'N -79.0234'W
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 0.20 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Gum Branch
proposed project:
2b. Water Quality Classification of nearest receiving water: C; Sw
2c. River basin: Lumber
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The project is located on NC 41 on the fringes of Lumberton. The surrounding area is urban, there is also heavy
pedestrian traffic within this area.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
76 linear feet culvert and 42 linear feet of rip rap
3d. Explain the purpose of the proposed project:
Bridge #446 was built in 1939 and rehabilited in 1959 and has since overlasted iYs useful life expenancy.
3e. Describe the overall project in detail, including the type of equipment to be used:
Impacts will be minimized as much as possible. A temporary pedestrian bridge will be built upstream. Then the bridge
will be removed and the culvert will be placed utilizing a track-hoe excavator. Proper backfilling will take place with track-
hoe excavators to bring the fill up to roadway elevations. Curb and gutter will be poured and handrails shall be installed.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past? ❑ Yes � No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary � Final
4c. If yes, who delineated thejurisdictional areas? Agency/Consultant Company:
Name (if known): ESI Other:
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 past? ❑ Yes � No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
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PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ❑ Yes � No
6b. If yes, explain.
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PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impactslnventory
1. Impacts Summary
1a. 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 Type ofjurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Temporar T
W1 ❑ P❑ T NA ❑ Yes ❑ Corps
❑ No ❑ DWQ
WZ � P� T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W5 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g. Total wetland impacts
2h. Comments:
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.
3 a. 3 b. 3c. 3d. 3 e. 3f. 3 g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ — non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
Culvert Gum Branch ❑ PER � Corps 76 LF
S1 � P� T RipRap Canal � INT ❑ DWQ 18ft 42 LF
(20 Temp)
S2 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S3 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S4 ❑ P � T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S5 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S6 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total stream and tributary impacts 76 LF
3i. Comments: 20 LF of temporary impacts resulting from dewatering operations both up and downstream. 20LF of Class 1 rip
rap shall be placed upstream and 22LF downstream for bank protection.
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PCN Form — Version 1.3 December 10, 2008 Version

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
impact number — (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent(P)or
Tem ora T
01 ❑P❑T NA
02 ❑P[IT
03 ❑P❑T
04 ❑P❑T
4f. Total open waYer impacts
4g. Comments: NA
5. Pond or Lake Construction
If pond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
Sf. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes � No If yes, permit ID no:
5i. Expected pond surface area (acres):
5. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
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.
6a.
❑ Neuse ❑ Tar-Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Bufferimpact
number— Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Tem orar T impact required?
81 ❑P❑T ❑Yes
❑ No
82 ❑P❑T ❑Yes
❑ No
B3 ❑P�T ❑Yes
❑ No
6h. Total buffer impacts
6i. Comments:
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PCN Form — Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Due to every utlitity imaginable, the constraints of the project area and funding; a culvert was choosen that would intergrate
into the surrounding area with as much ease as possible.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
A culvert design will significantly decrease construction time as opposed to bridge replacement. The culvert has been
designed to work around the utilities which are around the project area.
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 [hat 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
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type NA Quantity NA
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: 76 linear feet
4c. If using stream mitigation, stream temperature: � warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
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PCN Form — Version 1.3 December 10. 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. W ill the project result in an impact within a protected riparian buffer that requires ❑ Yes � No
buffer mitigation?
6b. 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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. 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).
6h. Comments: NA
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified � Yes � No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: ❑ Yes ❑ No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? 33 %
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:
Please see attached SM Plan.
❑ Certified Local Government
2e. W ho will be responsible for the review of the Stormwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? NA
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No
attached?
4. DWQ Stormwater Pro ram Review
❑ Coastal counties
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply � 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
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PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the � yes ❑ No
use of public (federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ❑ Yes � No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ❑ Yes � No
or Riparian Buffer Rules (15A NCAC 26 .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):
3. Cumulative Impacts (DWQ Requirement)
3a. W ifl 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.
Due to the minimal transportation impact resulting from this Bridge to Culvert project, this project will neither influence
nearby land uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study will not be necessary.
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.
NA
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PCN Form — Version 1.3 December 10, 2008 Version

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 USFW S concerning Endangered Species Act � Yes No
impacts? �
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program GIS Layer, Preliminary Ground Survey
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes � No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
USFWS website- http://www.fws.gov/nc-es/fish/fish.html
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. W ill this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation � Yes � No
status (e.g., National Historic Trust designation or properties signifcant in
North Carolina history and archaeology)?
7b. W hat data sources did you use to determine whether your site would impact historic or archeological resources?
NCDOT Cultural Resources office preformed an internal review through the Programmatic Agreement between State
Historic Preservation O�ce and NCDOT.
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes � No
Sb. If yes, explain how project meets FEMA requirements: NA
8c. W hat source(s) did you use to make the floodplain determination? NC Floodplain Mapping website (Tile # 9391)
Greg Bums, P.E. ? F�1s
. Gc� � ' � /� i��✓,—
ApplicanUAgenYs Printed Name � Applicant/AgenYs Signature Date
(AgenYs signature is valid only if an authorization letter from the applicant
is provided.)
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PCN Form — Version 1.3 December 10, 2008 Version

APPROVED JURISDICTIONAL DETERMINAT[ON FORM ��
U.S. Army Corps of Engineers G�^ �j j� �(� Ca,i.� �(
This form should be completed by foilowing the inshvctions provided in Section IV of the ID Form ]nstructional Guidebook.
SECTION I: BACKGROUND INFORMAT[ON � �
A. REPORT WMPLETION DATE FOR APPROVED JURISDICTIONAL DETERMINATION (JD):
B. DISTRICT OFFICE, FIL.E NAME; eWD NUMBER:
C. PROJECT LOCATION AND BACKGROUND INFORMATION:
State:NC Cwnry/puristi/6orough: Robeson City: Lumberton
Center coordinates of site QeUlong in degree decimal format): Lat 34.60779° ��'I, Long. 79.02346° �i?,
Universal Transverse Mercator: 17S 681232 3831324
Name of neares[ waterbody: Gum Branch Canal
Name of neazest Tradifional Navigable Water (TNW) Into which the aquatic resource tlows: Lumber River
Name of watershed ar Hydrologic Unit Code (HUC): �3040203
� Check if map/diagam of review area andJOr potentisl jurisdictional areas islare avaitabte upon request.
[] Check if other sites (e.g., offsite mitigution sites, disposat sites, etc...) are associated with [his acHOn and are recorded on a
different JD form. -
D. REVtEW PERFORMED FpR SITE EVALUATION (CHECK ALL THAT APPLI�:
Q Office (Desk) Determination. Da[e:
Q Field De[ermination. Date(s):
SCCTION II: SUMMARY OR FINDINGS
A. RHA SECTION 10 DETERMi1VATION OF JURISDICTION.
There �ck List "navigabte walers oj1T�e U.5." within Rivers and Harbors Act (RHA) jurisdiction (as defined by 33 CFR part 329) in the
review area. [RequiredJ
[� W aters subject to che ebb and flow of the tide.
Q Waters are presentiy used, or have been used in the past, or may be susceptible for use ro hansport interstaYe or foreign commerce.
Explain: .
B. CWA SECTION 404 DETERMINATION OF JURISDICTION.
There Are "waters aftGe U.5." within Clean Water Act (CWA) jurisdiction (as defined by 33 CFR part 328) in the review area. [Requiredj
1. Waters ofthe U.S.
a, Indicate presence of waters of U.S. fn review area (cheek aIl that apply): �
Q 1'NWs, including territoriat seas
Q Wetlands adjacent to 7NWs
� Relatively permanent waters2 (RPWs) that flow direcHy or indirectly into TNWs
� Non-RPWs that tlow directly or indireetly into T'NWs
� Wetlands directly abutting RPWs that flow directly or indirectly into TNWs
� Wetlands adjacent to but not direcUy abutting RP Ws that flow directly or indirecUy into TNWs
0 WeHands adjacent to non-RP Ws that flow directly or indirecUy into TN Ws
0 Impoundments of jurisdicfional waters
0 Isolated (inters[ate or intrastate) waters, inctuding iwlated wetlands
b. Identefy (estlmate) size of wa[ers of the U.S. in tfie revlew area:
Non-wetland waters: t50 tinear feet: 15width (ft) andlor acres.
Wetlands: acres.
c. Limits (boundaries) af Jurisdlctlon based on: �sta6lishgd�6y OH�}RN:
Elevation of es[ablished OHVJM (if known): .
2. Non-regulated wetershvetlands (check it appliceble):3
[] Po[entially}urisdictional waters andlor wetlards were ussessed within the review area and determined to be notjurisdicEional.
Explain: .
� Bozes checked 6elow sliatl 6e supported 6y compleling the appropriate scetions in Section IQ below.
' For purposes of this focm, an RPW is defined as a[ri6utary that is not a 1'NW and that typically flows year-mund or has con8nuous flow at least "seasonally"
(e.g., typically 3 months}.
3 Supporting documentetion is pasented in Seetion lII.F.

SECTIONIII: CWAANALYSIS
A. TNWS r#NA WETLANDS ADJACENT TO TNFVs
The egencies will assert jurisdiction over TNWs and wetlands adjscent to TNWs. If the aquatic resource ts a TNW, complete
Sechon II/.A.1 and Sectiort III.D.1. only; if the aquatic resource is a wetland adjacent to a TNW, complete Sectioas III.A.1 and 2
and Sectioa IIi.D.l.; othenvise, see Section III.B beIow.
i. 'IryW
Identify 7TVW:
Svmmarize rationale supporting determination:
2. WetlandadjacenttoTNW
Smnmarize retionale sapporting conclusion that wetland is "adjacenP':
B. CHARACTERISTICS OF TRIBUTARY (THAT IS NOT A TNV1� AND ITS ADJACENT WETLANDS (IF AN1�:
This sectlon summarizes informafion regarding characteristics of the hibutary aad its adjacent wetlauds, if any, and it helps
determine whether or nof the standards for jurisdictlon established under Rapn�ros Beve been met.
The agencies will assert jurisdiction over non-navigable trlbutaries nf TNWs where the tributartes are �relativeiy permanent
waters" {RPWs), i.e. tributaries that typically i}ow yeur-round or have conttnuous flow at least seasonally {e.g., typically 3
monYhs). A wetland that direetly ubuts an RPW is also jurisdictional. If the aquatic resource is not a 7'NW, but has yeer-round
(perenniel) flosv� sktp to Section III.D.2. If the aquatic resource is a weHand derectly ahutting a tributary with perenniel flow�
skip to Section III.D.4.
A wetland that is adjacent tn but that does not directly abut an RPW requires a significant nexus evaluation. Corps dlstricts and
EPA regions witl include in the record any available informatlon that documents [he existence af a stgnificanC nexus between a
relatively permanent tribuffiry that is not perennial (and its adjacent rvettands if any) and a traditiona[ navigable water� even
thaugh a signil3cant nexus finding is not required as n matter of law.
ff 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 signi(icant nexus with a TNW. If the tributary has adjacent wetlands, the signtficant nexus evaluation must
consider the tdbutary in eombination with all of its adjacent weNands. This sSgniRcant nexus evaluation that combines, Por
annlyticnl purposes, the tributary and all of its adjacent weHands is used whether the revlew area identified in tBe dD request is
the tributary, or its adjacent wetlands, ar hoth, It the JD covers a tributary }vfth adjacent wetlands, complete Section III.B.1 for
the tributary, SecHon III.B.2 for any onsite wetiands, and Section III.B3 for all weUands adjacent to that tributary, bath onsite
nnd ofCsite. The determination whe[her a significant nexus exists is determined in Sectlon III.0 belorv.
1. Characteristics of non-TNWs that flow directly or i¢directly into TNW
(i) Generel Area Conditions:
Watershed size: 1 SO acies
Drainage area; 150 �acr'e,"s,
Average annual rai�fali: 45.6 inches
Averege annual snowfall: 2 inches
(iij Physical Characteristics:
(a) Relationshin with TNW:
❑ Tributary flows directly into 1'NW.
� Tributary flows throagh 2 tri6utaries 6efore entering TN W.
Project waters are 1(or less) river mi]es from TNW.
Project waters are �1 (pr less) rivec miles from RPW.
Project waters are 7(or less) aerial (shaight) miles finm 1'N W.
Project waters are 1(orless) aerial (st[aight) miles from RP W.
Project waters cross or serve as state boundaries. Explain:
Idendfy flow route ro'i"NW°: Gum Branch Canal to Cotton Mill Branch to Lumber Rivec
Tributary stream order, if known: 2nd.
� Nole thet the InsW ctional Guideboak wntains additional info�mation regatding swales, ditcha, washes, and erosional feaNres generally and in the arid
Wa[.
s Flow route can be described by iden6fying, e.g., Vibutary a, whicb tlows [hrough the feview area, [o flo�v into Iributary b, which ilim flows info T7VW.

(b) General Tribufarv Characteristics (check all that annlv�
Tributary is: [] Natural
[] Arti6cia7 (man-made). Explain;
� Manipulated (man-altered). Explain: Channelized sheam in urban area.
Tributary properties with respect to top of bank (esfimate):
Average width: 15 feet
Average depth: 5 feet
Average side slopes: SEl.
Primary tributary substrate compoaition (check all that apply):
❑ Siits � Sonds ❑ Concrete
� Cobbles ❑ Grnvel ❑ Muck
❑ Bedrock � Vegetation. Typd%cover.
❑ Other. Explain: .
Tributary crondition/stabiliry [e.g, highly eroding, sloughing 6anks]. F�cplain: stable.
Presence ofrun/rittleJpool complexes. Explain: absent
Tributary geometry: Itela_yely,stceighi
Tributary gradien[ (approximate average slope): 0-4 %
(c) Flow:
Tributary provides for. 6easou@I�floi�?
Estimate average number oF flow events in review area/year. 20 (or greater)
Describe flow regime: .
Other ioformation on dura[ion and volume: .
Sudace flow is: Confined. Cheracteristics:
Subsurface tlow: TJntcno�n. Explain 6ndings:
❑ Dye (or other) test performed: .
Tributary has (check all that apply):
� Bed and banks
� OfIWMb (check alI indicators that apply):
� elear, natural ]ine impressed on the bank [j
❑ changes in the character of soil ❑
❑ shelving �
� vegetation matted down, bent, or absent ❑
� leaf litter disturbed or washed away ❑
� sediment deposition ❑
� water staining Q
❑ other (Iist):
� DisconHnuous OHWM � Explain: .
the presence of litter and debris
deshve[i0n of telrestrial vegetation
the presence oF wrnek line
sediment sorting
scour
multipleobserved orpredicted flow evenis
abrupt change in plant community
[f factors other than the OH WM were used to determine lateral extent of CWA jurisdiction (check all that apply):
0 Aigh Tide Line indicated by: ❑ Mean High Water Mazk indicated hy;
❑ oil or scum line along shore objects ❑ survey to available datum;
❑ fine shell or dehris deposits (foreshore) ❑ Physical mArkings;
❑ physical markings/characteris6cs ❑ vegetetion lineslchanges in vegetation types.
❑ 6dai gauges
❑ other (list):
(ili) Chemical Charactedstics:
Cheracterize tributary (e.g., water cotor is ciear, discolared, oily film; water qualiry; generat watershed characteristies, etc.).
Explain: water is clear.
IdenNfy specific pollutants, if known: runofffrom nearby mads and yards.
°A nsturai or man-madediscontinuity in the OtR'!M does not necessarily severjurisdiction (c.g., whero the stream temporarily Flows undergmund, orwhere
the OHWM has bern removed by development or agriculturet practices). W6ere there is a 6ceak en the OHWM tAat is unrelated m the waterbody's flow
regime (e.g., flow over a rock outcrop or through a culverlj, the agencies will look Por indicaioes of Row a6ove and below Fhe break
�lbid.

(iv) Biologtcal Chnracteristics. Channel supports (check all that apply):
❑ Riparian wrtidor. Characteristics (type, averege width): .
❑ Wetland fringe. Cha�acterisYics: .
❑ Habitat for:
❑ Fedaratly Listed species. Exptain findings: .
❑ Fish/spavm areas. Explain findings: .
❑ Other environmentally-sensifive species. Explain findings:
❑ Aquatic/wiFdlife diversity. Explain fndings: .
2. Charactedsttcs of wetlands adjacent to non-TNW that flow directly ur indirectly tn[o TNW
(i) Physicat Characteristics:
(a) Genaal Wetland Characteristics:
Properties:
Wetland size: acres
Wetland tyye, Ecplain: .
Wetland qualiry. Explain: .
Pmject wetlands aoss or serve as state boundaries. Explain:
(b) Generai Flow Retationshin with Non-TNW:
Flow is: PicicList. Exglain: .
Surface flow is: ick Lis�
�...�,�
Characteristics:
... Subsurface flaw: gick List. Ezplain findings:
[] Dye (or other) test perfortned: .
(c) WetlandAdjecencv➢eterrninationwithNon-7'NW:
❑ Directly abutting
❑ Not directly abutting
❑ Discrete wedand hydrologic connecfion. Explain:
❑ Ecological connection. Explain: .
❑ Separated by bevrilbamer. Eaplain: .
(d) Proximity (Relationshinl to TfVW
Project wetlands are kick L'ist river mites from 1'NW.
Project waiers are Pick L3st aerial (straight) miles from TN W.
Flow is from: �Picklis�.
Estime[e approximate location of wettend as within the Pick,List floodplain.
(ii) Chemicel Characteristics:
Characterize wetland system (e.g., water color is clear, brown, oil film on surface; wa[er qualiry; general watershed
characteristics; ete.). Explain: .
Identify specific pollutants, if knowci: .
(iii) Biological Characteristics. Wetland supports (check sll that apply):
0 Riparian buffer. Characteristies (type, average width): .
❑ Vegetation type/percent cover. Explain: .
❑ Habitat for.
❑ Federally Listed species. Explain findings: .
❑ Fishfspavm areas. Explain findings: .
❑ Qther environmentally-sensitive species. Explain findings:
❑ Aqua6dwildlife diversity. Facplain findings: .
3. Characteristics of all wetlands adjace¢t to the tributary (if any)
All wetland(s) being wnsidered in t6e cumu�ative anatysis: Ptek List
Approximately ( ) acres in totai are being considered in the cmnula6ve analysis.

For each wetland, specify the following:
Directiv abuts? (YIN) Size (in acresl DirecNv abuts7 (YlNI Size (in acres)
Summarize overall 6iological, chemical and physical Ponctions being performed: ,
C. STGNIFICANT NEXUS
A significant nexux enalysis will assess the flow characteristics und funeHans of the tri6utary itself and the functions performed
by any wetlends adjacent ro the tri6utary to determine if tfiey significantly affec[ the chemical, phys3cal, and 6tological integrlry
of a TNFV. For each of the fo0owing sGtuations, a signi£cant nexus exists if the tributnry, in combinatian with all of its adjecent
wetlands, has more than a speculative or insubstantial effect on the chemical, physical and/or biological integrity of a TNW.
Considera[ions when evaluatfug signtticant nexus include, but are not limited to the volume� duratfovy and freque�cy of the flow
of water in the tributary and its proximity to a TNW� and the funetions performed by the tributary a¢d all its adjacent
�retfands. It is not appropriate to determine significant nexus based solely on any specific threshald of distanee (e.g. between a
tributary and its adjacent rvetland or behveen a tr[butary and the TN�. Similarly, the fact an adjacent we8and Iies �vithin or
outside of a floodplain ts not solely determinadve of signit3cant nexus.
Draw connections behveen the featares documented and the effects o¢ the TNW, as identified in the Rapmms Guidance and
dtscussed in the Instructional Guidebook. Factors to consider include, for example:
• Does the hibutary, in combination with its adjacen[ wetlands (if any), have the capacity to carry pollutants or flood waters to
TN Ws, or to reduce the amount of pollutants or flood waters reaching a 7'N W?
• Does the fibutary, in eombination with its adjacen[ wetlands (if any), provide habitat and lifecycle support funetions fot 6sh and
other species, such as feeding, nesting, spawning, or rearing young for species that are present in the TN W?
� Does the fibutary, in com6ination with its adjacent wetlands (if any), have the cepaciry to iransfer nutrients and organic carbon that
support downsheam foodwebs?
• Does the hibutary, in combinnfion with its adjacent we8ands (if any), have other relationships to the p6ysical, chemicai, or
biological integrity of the TNW?
Note: the above list of considerations is not Inclusive and ot6er functions observed or known tu occur should 6e documented
below:
1. Significant nexus findings for non-RPW that Ras no adjacent wetlands and Ilows direct[y or indirectly into TNWs. Explain
findings of presence or absence of significant nexus below, based on the tributary itself, tlien go to Secfion III,D:DA flows directly
into Bum Coat Creek outside of review area
2. Signifeant nexus findings for non-RPW and its adjacentwettands, where the non-RPW ilows directly or indirecily into
TNWs. Explain findings of presence or absence of significant nexus below, based on the dibutary in combination with all of its
adjacent wetlands, then go to Section III.D: .
3. Significant nexus Fndings for wetlands adjacent to an RPW but that do not dfrecUy abut the RPW, Explain findings of
pcesence or abseace of significent nexus below, based on the tributary in combinaHon with all of its adjacent we8ands, then go to
Section III.D: .
D. DETEIL�7INATION5 OF JURISDICTIONAL FINDINGS. THE SUBJECT WATERS/WETLANDS ARE (CHECK ALL
THAT APPLl�:
1`NWs and AdJacent Wetlands. Check all that apply and provide size esNmates in review area:
❑ 7'NWs: linear feet width (ft), Or, acres.
❑ WetlandsadjacenttoTNWs: acres.
2. RPWs that flmv directly or indirecNy into 1'NWs.
� Tributaries of 1'NWs where tributaries typically flow year-round arejurisdictional. Provide data and retionale indicating that
tributnry is perennial:
� Trihutaries ofTNW where tributaries have wntinuous flow "seasonall�' (e.g., typically three months each year) are
jurisdictional. Data supporting this conelusion is pmvided at Secrion ISI.B. Provide rationale indicating that hibutary flows
seasonally: Gum Branch Canal (SA) scored a 25.5 on the NCDWQ Stream ldentifrcation Fonn.

Provide estimates for jurisdicNonal waters in the review ecea (check all that apply):
� Tributary waters: 150 linear feet 15 width (ft).
❑ Othernon-wetlendwaters: ecres. '
IdenHfy type(s) of waters: .
3. Non-RPWsE t6at floia directly or indirectly into TA'Ws.
0 Waterbody that is not e TN W or an RPW, but flows directly or indirecAy into a TNW, and it has a significant nexus with a
TNW is jurisdictional. Data supporting this conctusion is provided at Section III.C.
Provide estimates for jurisdictional waters within the revlew area (oheck e{I that apply):
0 Tributary waters: linear feet width {ft).
❑ ptNer noo-wetland waters: acres.
Identifytype(s)oFwatees; .
4. WeBandsdirectly abutting an RPW that flow directly or ind3rectly into TN"N's.
� Wet(ands directly abut RPW and thus arejurisdictional as adjacent wettands.
❑ Wedands direcdy abutting an RPW where tributaries typical]y flow year-round. Provide data and iafionale
indica6ng that fibutary is perennial in Section III.D2, abave. Provide rafionale indicating that wetland is
directly abvtting an 32PW: .
❑ Wetlands directly abutting an RP W where tributaries typically flow "seasonally." Provide data indieating that hi6utary is
seasonel in Section III.B and ratiooale in See6on III.D.2, above. Provide rafionale indicaring that wetland is directly
abutting an RPW: .
Provide aereage es6motes forjurisdiotional rvetlands in the review area: acres.
5. Wetlands adjacent to but not directly abutting an RFW that flow directly or indirectly tnto TNWs.
❑ Wetlands that do not directly abut an RP W, bnt when considered in combination with the tributary to which they are adjacent
and with similady situated edjacent wetlands, have a significant �exus with a TNW arejurisidictional. Data supporting this
wnclusion is provided at Sec6on III.C.
Provide acresge estimates for jurisdicdonai wetlands in the review area: aeres.
6. Wetlandsadjacent to non-RPWs that flow directly ur indirectly into TNWs.
❑ Wettands adjacent to such waters, and have when wnsidered in combination with the tribumry to which they are adjacent and
with similarty situated adjacent weHands, have a significant nexus with a TNW arejurisdictional. Data supportrng this
conclusion is provided at Section III.C.
Provide astimates forjurisdictionat wetlands in the review area: acres.
7. [mpoundments ofjarisdictional waters °
As a general rule, the impoundment of a jurisdietional h'ibutary remains jurisdicfionat.
[j Demonsha[e 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
❑ Demonsh'ate that water is isolated with a nexus to commerce {see E below).
E. ISOLATED [INTERSTATE OR INTRA-STATE] WATERS, INCLUDING ISOLATED WETLANDS, THE USE,
DEGRADAPION OR DESTRUCTION OF WHICH COULD AFF�CT iNTERSTATE COMMERCE, INCLUDCNG ANY
SUCH WATERS (CHECK ALL THAT APPL1�:10
� which aze or could be used by interstate or fureign trqvelers for recreadonal or other purposes.
❑ from whioh fish or shellfish ere or could he taken and sold in interstate or foreign commerce.
❑ which are or could be used for indushial pucposes by industries in interstate commerce.
❑ Interstate isola[ed waters, Explain: . .
❑ Otherfactors. $xplain: . �
'See FootnoteN 3.
9 To complele [he analysis refer to Ihe key in Smlion ![I.D.6 of fhe 7nstruclional Guidebook.
1D Prlor to asserting or declining CIVAjurisdiction 6ased solely on this cetegory, Corps Districts wID elevate the action to Corps end EPA AQ for
review consisYent wit6 Ue process descdbed io t6eCorps/EPAMemoraeAnm RegardFng G7VA ActJurlsAletton Falfowing Rapanos

Identify tvater 6ody and summaHze rationale supporting determination:
Provide estimates for}urisdicHonal waters in the review area (check all thet apply):
J] Tributary waters: ]inear feet width (ft}.
❑ Other non-wetland waters: acres.
Iden6fy type(s) o£watecs: .
p Wetlands: acres.
F. NON-JURISDICTIONAL WATERS, INCLUDING WETLANDS (CHECK ALL THAT APPLI�:
� If potendal wetlands were assessed within the review area, these areas did not meet the criteria in the 1987 Corys of Engineers
Wetland Delineation Ma»ua1 and/or eppropria[e Regional Supplements.
[l Review area inciuded isalated waters with no substantial nexus to interstate (or foreign) commerce.
❑ Prior to the 1an 2007 Supreme Court decision in "SVYANCC," the review azea would have bcen mgulated hased solelv on the
"Migretory Bird Rule" (MBR).
� Waters do not meet the "Significant Nexus" standard, where such a finding is required forjurisdiction. Explain:
Q Other. (explain, if not covered above): .
Provide acreage estimates for nonyurisdictional waters in the review area, where the sole potenfial basis of jurisdicdon is the MBR
factors (i.e., presence of migratoN birds, presence of endangered specias, use of water for irrigated agriculNre), using bes[ professional
judgment (check all that apply):
❑ Non-wetland waters (i.e., rivees, shwms): linear feet widih (ft).
❑ Lakes/ponds: aeres,
�� 0 Other non-wetland waters: acres. List type ofaquatic resource: .
❑ Wetlands: acres.
Provide acreage esHma[es for nonyurisdietional waters in the review area that da not mcet the"Signi£cant Nexus" standard, where such
a finding is required for jurisdicfion (check atl Ihat apply):
Q Non-wetland waters (i.e., rivers, sheams): linear feet, width (ft).
� Iakeslponds: acres.
j] Other non-wedand waters: acres. List type of aquatic resource: .
� Wetlands: acres.
SECTION IY: DATA SOORCES.
A. SUPPORTING DATA. Data reviewed for JD (cheek aR thaf apply - checked items shall be included in case fite and, where ck�ecked
and requested, appropdately reference sources below):
� Maps, ptans, plots orplat submi8ed by or on behalf oFthe applicanUconsulYend Environmental Services, Inc.
� Data sheets prepazed/submitted 6y or on behalf of the applicanf/consultant.
❑ Office concurs with data sheets/detineation report.
❑ Offlce does not concur with data sheets(delineation report.
❑ Data sheets prepazed by the Coips: .
� Corps navigable waters' study. .
❑ U,S. Geological Survey Hydrologic Atlas: .
❑ USGS NHD data.
❑ USGS 8 end 12 digit HUC maps.
� U.S. GeoIogica3 Survey map(s). Cite scale & quad name: SW Lumberton, NC 1:24000.
� USDA Natural Resoumes Conservation Service Soil Survey. Citation: Soil Survey of Robeson CounTy, NC.
❑ Nationa[ wetlands inventory map(s). Cite name: .
� State(Local wetland inventory rnap(s}: .
❑ FEMA/FIRM maps:
❑ 100-yearFloodplain Elevarion is:� (Na6onal Geodecde Verticai Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Dnte}: .
or � Other (Name & Date)_ .
� Previous detenninaGOn(s). File no. and dake of response letter. ,
� Applicablefsupporting case law: .
[] Applicabletsupporli�g scientific litereture: .
[] Other infonnation (please specify): .
B. ADDITIONAL COMMENTS TO SUPPORT dD:

USACE AID.'-'- DN�Q
Site � �?� (indicate on at7ached m:�p)
�;� STR�AM QUALITY ASS�SSMENT WORKSA��T
Procide tl�e folio�ving information Tor the strenm reacli under Assessment:
I. Applicant's name: NC�QT- �tasm, `-i4� 2. Evaluators name: .�ST �(I._ 'I______.,,.,tH��
3. Date ofevaluetion:T//� 4. Timeofee�luation: l/
6.Namaofsiream: ��ou�, (f�4w,rA ��� G.Riverbasin: %icw,.dv ,
7. Approximate drainage area: 8. Sh•eam w�der:_ Z� d
9. Lenglh ofreacli evaluated: /�Q �'� 10. Cou�ty: r�G�s'� .
11. Si(e coordinntes (if kr.ox�n): prefer in decimal degrees. 32. Subdivision name (if any);_ N�A
Lnr�ua�c��.a4.s�z3�z,: �`f.6o779 Lonsiliide(cz.-77..i5661i): -%�J.(I27Y�
t�4ethod locaflon detennined (circlej: GPS Topo Sheet o fAerial Photo/ Olher G1S O�her
]3. Location ofreach mider e��aluation (izoie nearUy roads and laiidmarks and attach map iden[ifying sheam(s} locntion}:
'� l�IG � I�P1�-� L�ts.<.- k�.,, � 5�. .`I�.,'t�� ovar �,... 13.- � 4 Ce,.�,.o- l
, _.
14. Proposed chTnnel work {if any): T�� �� /.,�e�„�., �
I5. 2ecent �i�eather conditions. �a � ce /c(
IG. Sife conditions at time ofvisit: sfi-a�Ca- �%�,,,,,,,t , 4 wi� wti:a� w�ae..�4..t
_ �
17. Identify any specia] �sater�vay classifications known: ^Section 10 _Tida] ���aters _Gssential Fisheries Hnbitat
„`Troul Waters _Ouistanding Resoume Waters ,�,Nuirient Sensitive Waters �Wnter Supply WaterShed,�Q-N}
IS. ts there a pond or ]ake localed upsTream ofthe e��aluation point? 1'CS �O Ifyes, estimnte the �;�ater surface area:
19. Does channei appear on USGS qaad map? YE NO 20. Does channel appear on USDA Soil Survey? YCS NO
21. Cstimated �+�atershed land use: 2!� ;-o Residential _%a Commercial _% Industrial _°%Agriculturnl
`�� %'o Forested _°'o Cleared / Logged _°'o Other (
22. Sankfull �aidth:_ I��"• 23, Bank hei�ht (Prom bed to top of bank): S�
24. Channel slope do�+m center of stream: ✓at (0 to 2;�o) �Gentle (2 to 4°6} _Moderate (4 to 10°JO} _Steep (> I 0;'o)
Z5. Channel sinuosity: �raielii _Occasional bends _Frequent meander _Verv siiivais _Brai�ed channel
insfructions fm• completion of worl:sheet {located on pagc 2): Begin by detenninin� the most appropriale ecore�ion oased on
location, terrain, vegetation, sh�eam classification, etc. Crery� characteristic must Ue scored using the sa�ne ecorz�ion. Assign poinEs
to each characteristic �i�ithin the range sho�+�� for the esore�ion. Page 3 provides a Urief description of how to revie��� the
characYeristics identified in the �a�orksheet. Sew•es should reflect an oaerall assessmenY of the su•eam reach under evalua�ion. If a
characteristic cannot Ue evaluated due to site or �reather conditions, enter 0 in Ihe scoring box and provide an explanation in the
comment secYion. Where there are oUvious changes in ihe character of a stream under revie�i� (e.g.. the stream flo�vs from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate forn� used to e��aluate each
reach. The total score assigned to a stream reach must ran�e behveen 0 and 100, with a score of 100 represenYing a sheem of the
hi�iest qualiri.
Tofnl Score (Trom reverse):� Comments: L'�ie �,o! z�( J/�-�iw. rk k..6n,., a�
E��ntnntor's Sigunture �rN� % �7"��''�� Date l�Z I�1.aiT
T6is ciiannel et•aluation Pm�m is intended to Ue used onl}� as a guide to nssisY landotiruers an env�ironmeu4al professionals in
gnfhering the data required by the United Stntes .4rm�� Cor�s of Lngineers fo make a preliminary �ssessroent of stream
quality. Tlte tofal scm•e resuhing 4�oni flee com�letiou of ticis form is subjeM fo USACL approvai and does not imply a
particular mitigation e-atio or requirement. Form sub,ject to change - version 06r03. To Comtnent, please call 919-876-84�#1 x 36.

STREAM QUALITY ASSESSMENT WORKSH�ET
, , , , ; �COR�GION EOINT Y2AN��+ � �
# � ' � '.' CHAItACT�RTSTICS��`� �,%' 'Cosstal ��Piedtnoi�t�' '4Iquntain �����
yi Presence of flow ! persistent pools in stream 0– 5 0– 4 0– 5 �
(no floG�� or saturat�on = 0• shon flow = max oints
2 _ Evidence of pnsf human nlferation 0– 6 0– 5 0– 5
(eate��sive alieration =:0; no alteration = ma�c oints) �
� '� Riparian zone
?„' 3 (no buffer – 0; conti uous, w9de buffer = wax oinfs 0– 6 0 4 0– 5 �
�7 Eyidenae of npti•ient a• chemical diseLarges
¢ (exterisive dischai es = 0� no'dischaz es =max oints 0– S . i 0– 4 0– 4
Groundtvater discHar e _ '
� 5 g �-3 0-4 0-4; �
l�; no disch e 0; s irin s see s, �vetlands eto. – max oints
r..f� Presence af adjncent �loodplain
ra g p_q p_q p_2'
y„ no floodpla�n = 0; extensive flood ]ain =maac points) �
Kq. ' ` EntreneLment / iloodplain aecess
�' � deepl entrenclied = 9; frequent floodin .= max oints} `. 0– 5 !' 0– 4 0– 2` �
�. � 8 presenceofadjacentu�etlarids ' ' 0-6 0-4 0 2' Q
(no �i�etlands = O; lar e adiacent watlands = max oiuts}
� q Chnnnelsinuosity ` p-5 0-4 0-3 Q
(extensive channelization = 0; natwgl nieander=maac oinfs
, 19 r Sediment input ' �_ 5 `' �_ 4 � 4
,, ; extensive deposition= O; little prno sediment =max ints� �
I1 $�ze & di��ei•sity of chauuei bed sulistrate : '�A* Q-4 0– 5 —
jfine, homo enous = Q;1ar e diverse sizes = max oints)
E��idence of clTanne] incision or tiyidening 5
; y, IZ (deepl incised = 0; sfable bed & banks = inax oints} 0– 5 ' 0– 4 0– 5
H= Presence of major 6ank failui-es
13 6-5 0-5 0-5 �
d'- {severe eiosion = 0; no erosion stable banks = max points}
,�14 Root depth and density on banks 0– 3 0– 4 0– 5 �
; (no visible rodts = �; dense roots throa hout = max oints)
� Tmpact by agricn)ture, livestocly or timber production
15 substantial impact =0; no evidence = max oinfs �– 5 0– 4 0– 5 ° s
'- 16 Presence of i•iffle-poollripple-pool complexes �_ 3 p_ 5' Q– 6 O
� (no riffleship les or ools = 0; well-develo ed – max oints)
:�� ,�. . �. � FTabitatcomplexity „ �...
�� 0-6 0-6 0-6
„E'li Iittle oi� no habitat = 0; frequent varied habitats = mae oints) �
Canopy coverage over streambed
]8 ° 0-5 0-5 0-5
� noshadin ve etation–O;COntinuousoano =mexpoints) �
Spbsfrate embeddedness * '
19 (dee 7 embedded = U; loose structure = max xA , 0 4 I 0– 4 �
Presence uf stream inverfebrates (see page 4)
20 �-4 �-5 0-9 I
� (noevidence-0�common,numerous es=max oints) f
C21 A•esenceofamphibians 0-4 0-4 0 4 �
(no evidence = 9; do�runon, numerous es = uiax oims
�' ` 1'reseneeoffish
O 22 0-4 ' 0-4 0-4 : �
�, (no evidence – 0; common, niuneraus es = max oints
23 Evidenceofwildlifeuse' 0-6 0-5 6 5
no ev�dence = 0� ahundant evidence – max oints J �
� . TotalPomtsPassible ;. IQO ; - iO4 I00 '`
- : TOTAL: SCOIiE (also entei on first page} j 7
* These characteristics a�•e noi assessed in coastal streams.
�

Data: J�LI�� �
Evaluator: �'S.T r'C. �4(N6NII/
Total Poinfs:
SY/eamtsatkeatintermkMnt 2�5'
i12i9or ronnlaiift30`
A. Geomor holo (Subtotal =
1° Continuity of channel bed and bank
2. Sinuosity of channel along thahveg
3. In-channel structure: ex, rif(le-pool, s
rf te- ol se uance
4. Particle stze of sheam subshate
5. Active/rellct floodplain
6. Depositional bars or 6enches
7.Jtecent alluviai deposits
8. Headcuts
9. frade mntrol
1 Q. Naturel vaAey
11, Second or greater order channel
aHifialal tlitches are not ratetl; see dlscussio
B. H drology fSubtofal = g,S
12. Presence of Baseflow
93. Iron oxidfzing bacterla
74. Leaf litter
15. Sediment on plants or debris
16. Organfc debns Ilnes ar piles
17. Sop-based evidence of high water tal
C. Bi010qy (S�btotal = 5� 1
18. Fibrous rools in streambed
19. Rooted uptand plants in sireambed
20. Macrobenthos (note dlversity and abund
21. Aquatic Mollusks
22. Ffsh
23. Crayfish
24. Amohibians
In
�d piants in streambed �
streams may sls0 be identified using ofher methods. See
Sketch: s�
\ �` SA�
�v
S�
�ersFon 4.11
ProjectlStte:�j,u�„ �fc(� LatRude;3y. f,p���j
County: J2oLu�, l.ongitude: �7a.(3Z7y 6
StreamDe m�n ctrcleone} pfMer S�/Lti�b��
Ephemer�fntermlftent rennta} e.g.4uedName:
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.a-� 1.5
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