20160014 Ver 1_USACE JD Request Package__August 2015_20151229

Jurisdictional Determination Request
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US Army Cvrps
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This form is iniended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Co�rps). Please include all supporting
information, as described wiihin each category, with your request. You may submii your request
to the appropriate Corps Field Office (or project manager, if known) via mail, electronic mail, or
facsimile. A current list of county assignments by Field Office and project manager can be
found on-line at: htt�p://www.saw.usace.army.mil/Missions/Re ug lator_yPermitPro _gra�px , by
telephoning: 910-251-4633, or by contacting any of the field offices listed below:
ASHEVILLE REGULATORY FIELD OFFICE
US !\nny Coips of Engineers
151 Patton Avcnue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Anny Corps of Engincers
3331 Heritage Trade Drive, Suite 105
Wakc Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Strect
Washington, North Carolina 27889
Genexal Nuinber: [phone]
Fax Nuinber: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Anny Corps of Enginecrs
69 Darlington Avenuc
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
Version: December 2013 Page 1

Jurisdictional Determination Request
INSTRUCTIONS:
All requestors must complete Parts A, B, C, D, E and F.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part G.
NOTE ON PART D— PROPERTY OWNER AUTHORIZATION: Please be aware that all JD
requests must include the current property owner autharization for the Corps to proceed with the
determination, which may include inspection of the property when necessary. This form must be
signed by the current property owner to be considered a complete request.
NOTE ON PART D- NCDOT REQUESTS: Property owner authorization/notification for JD
requests associated with North Carolina Department of Transportation (NCDOT) projects will be
conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD may not
be valid for the wetland conservation provisions of the Food Security Act of 1985. If you or
your tenant are USDA Program participants, or anticipate participation in USDA programs, you
should also request a certified wetland determination from the local office of the Natural
Resources Conservation Service, prior to starting work.
Version: December 2013 Page 2

A.
�i
C.
Jurisdictional Determination Request
PARCEL INFORMATION
Street Address:
City, State:
County:
Directions:
Parcel Index Number(s) (PIN):
REQUESTOR INFORMATION
Name:
Mailing Address:
Telephone Number:
Electronic Mail Address i :
See attached Tax Parcel Cards
NCDOT
1598 Mail Service Center, Raleigh, NC 27699-1598 to Attention: ECAP
Select one:
� I am the current property owner.
❑ I am an Autharized Agent or Environmental Consultant2
❑ Interested Buyer or Under Contract to Purchase
❑✓ Other, please explain.
NC Department of Transportation
PROPERTY OWNER INFORMATION
Name:
Mailing Address:
Telephone Number:
Electronic Mail Address3:
❑ Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel/Tax Record data)
1 If available
Z Must attach completed Agent Authorization Form
3 If available
Version: December 2013 Page 3

Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION4
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on-site investigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.
Property Owner (please print)
Property Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
Date
� I am requesting that the Corps provide a preliminarX JD for the property identiiied herein.
This request does include a delineation.
� I am requesting that the Corps provide a preliminarX JD for the property identified herein.
This request does NOT include a delineation.
� I am requesting that the Corps investigate the property/project area for the presence or
absence of WoUSS and provide an a�roved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
� I am requesting that the Corps delineate the boundaries of all WoUS on a property/project
area and provide an approved JD (this may or may not include a survey plat).
� I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey 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
ALL REQUESTS
Map of Property or Project Area (attached). This Map must clearly depict the boundaries
of the area of evaluation.
� Size of Property or Project Area 6.43 (Project Area) acres
�
G.
I verify that the property (or project) boundaries have recently been surveyed and marked
by a licensed land surveyor OR are otherwise clearly marked or distinguishable.
JD REQUESTS FROM CONSULTANTS OR AGENCIES
(1) Preliminary JD Requests:
❑✓ Completed and signed Preliminary Jurisdictional Determination Form�.
�✓ Project Coordinates: 36.498460 Latitude 79•541767 Longitude
Maps (no larger than llx17) with Project Boundary Overlay:
❑✓
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�
❑✓
Large and small scale maps that depict, at minimum: streets, intersections, towns
Aerial Photography of the project area
USGS Topographic Map
Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
6 See Appendix A of this Form. From Regulatory Guidance Letter No. 08-02, dated June 26, 2008
Version: December 2013 Page 5

Jurisdictional Determination Request
Delineation Information (when applicable)�:
Wetlands:
� Wetland Data Sheets$
❑✓
❑�
�
Upland Data Sheets
Landscape Photos, if taken
Tributaries:
� USACE Assessment Forms
❑✓ Other Assessment Forms
(when appropriate)
Field Sketch overlain on legible Map that includes:
■ All aquatic resources (for sites with multiple resources, label and identify)
■ Locations of wetland data points and/or tributary assessment reaches
■ Locations of photo stations
■ Approximate acreage/linear footage of aquatic resources
(2) Approved JDs including Verification of a Delineation:
� Project Coordinates:
Latitude
Maps (no larger than llx17) with Project Boundary Overlay:
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�
�❑
�
�I
Longitude
Large and small scale maps that depict, at minimum: streets, intersections, towns
Aerial Photography of the project area
USGS Topographic Map
Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)
' 1987 Manual Regional Supplements and Data forms can be found at:
http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits/re� supp.aspx
Wetland and Stream Assessment Methodologies can be found at:
http://portal.ncdenr.org/c/document librarv/aet file?uuid=76f3c58b-dab8-4960-ba43-45b7faf06f4c&�roupld=38364 and,
http://www.saw.usace.armv.mil/Portals/59/docs/regulatory/publicnotices/2013/NCSAM Draft User Manual 130318.pdf
$ Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
Version: December 2013 Page 6

Jurisdictional Determination Request
Delineation Information (when applicable):
Wetlands:
� Wetland Data Sheets9
�❑
�❑
�❑
Upland Data Sheets
Landscape Photos, if taken
Tributaries:
� USACE Assessment Forms
� Other Assessment Forms
(when appropriate)
Field Sketch overlain on legible Map that includes:
• All aquatic resources (for sites witih multiple resources, label and identify)
• Locations of wetland data points and/or tributary assessment reaches
• Locations of photo stations
� Approximate acreage/linear footage of aquatic resources
Supporting Jurisdictional Information (for Approved JDs only)
�
❑�
Approved Jurisdictional Determination Form(s) (also known as "Rapanos
Form(s)")
Map(s) depicting the potential (or lack of potential) hydrologic connection(s),
adjacency, etc. to navigable waters.
9 Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
Version: December 2013 Page 7

Jurisdictional Determination Request
REQUESTS FOR CORPS APPROVAL OF SURVEY PLAT
Prior to final production of a Plat, the Wilmington District recommends that the Land
Surveyor electronically submit a draft of a Survey Plat to the Corps project manager for
review.
Due to storage limitations of our administrative records, the Corps requires that all hard-
copy submittals include at least one ori inal Plat to scale) that is no lar�er than 11"x17"
(the use of match lines for larger tracts acceptable). Additional copies of a plat, including
those larger than 11"x17", may also be submitted for Corps signature as needed. The
Corps also accepts electronic submittals of plats, such as those transmitted as a Portable
Documeni Format (PDF) file. Upon verification, the Corps can electronically sign these
plats and return them via e-mail to the requestor.
(1) PLATS SUBMITTED FOR APPROVAL
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❑�
Must be sealed and signed by a licensed professional land surveyor
Must be to scale (all maps must include both a graphic scale and a verbal scale)
Must be legible
Must include a North Arrow, Scale(s), Title, Property Information
Must include a legible WoUS Delineation Table of distances and bearings/metes
and bounds/GPS coordinates of all surveyed delineation points
Must clearly depict surveyed property or project boundaries
Must clearly identify the known surveyed point(s) used as reference (e.g. property
corner, USGS monument)
When wetlands are depicted:
• Must include acreage (or square footage) of wetland polygons
• Must identify each wetland polygon using an alphanumeric system
Version: December 2013 Page 8

Jurisdictional Determination Request
� When tributaries are depicted:
� Must include either a surveyed, approximate centerline of tributary with
approximate width of tributary OR surveyed Ordinary High Water Marks
(OHWM) of iributary
� Must identify Each tributary using an alphanumeric system
• Must include linear footage of tributaries and calculated area (using approximate
widths or surveyed OHWM)
• Must include name of tributary (based on the most recent USGS topographic
map) or, when no USGS name exists, identiiy as "unnamed tributary"
� all depicted WoUS (wetland polygons and tributary lines) must intersect or tie-to
surveyed project/property boundaries
� Must include the location of wetland data points and/ar tributary assessment
reaches
� Must include, label accordingly, and depict acreage of all waters not currently
subject to the requirements of the CWA (e.g. "isolated wetlands", "non-
jurisdictional waters"). NOTE: An approved JD must be conducted in order to
make an official Corps determination that a particular waterbody or wetland is not
jurisdictional.
� Must include and survey all existing conveyances (pipes, culverts, ete.) that
transport WoUS
Version: December 2013 Page 9

Jurisdictional Determination Request
(2) CERTIFICATION LANGUAGE
� When the entire actual Jurisdictional Boundar. i�picted:
include the following Corps Certification language:
"This certifies that this copy of this plat accurately depicts the boundary of the jurisdiction
of Section 404 of the Clean Water Act as determined by the undersigned on this date.
Unless there is a change in the law or our published regulations, the determination of
Section 404 jurisdiction may be relied upon for a period not to exceed five (5J years from
this date. The undersigned completed this determination utilizing the appropriate Regional
Supplement to the 1987 U.S. Army Corps of Engineers Wetlands Delineation Manual."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
� When uplands ma,y be present within a depicted Jurisdictional Boundar�
include the following Corps Certification language:
"This certifies that this copy of this plat identifies all areas of waters of the United States
regulated pursuant to Section 404 of the Clean WaterAct as determined by the
undersigned on this date. Unless there is change in the law or our published regulations,
this determination of Section 404 jurisdiction may be relied upon for a period not to exceed
five years from this date. The undersigned completed this determination utilizing the
appropriate Regional5upplement to the 1987 U.S. Army Corps of Engineers Wetlands
Delineation Manual."
Regulatory Official:
Title:
Date:
USACE Action ID No.:
Version: December 2013
Page 10

Jurisdictional Determination Request
(3) GPS SURVEYS
For Surveys prepared using a Global Positioning System (GPS), the Survey must include
all of the above, as well as:
� be at sub-meter accuracy at each survey point.
� include an accuracy verification:
One or more known points (property corner, monument) shall be located with the
GPS and cross-referenced with the existing traditional property survey (metes and
bounds).
� include a brief description of the GPS equipment utilized.
Version: December 2013 Page 11

ATTACHMENT A
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
Jason Dilday
NCDOT, 1598 Mail Service Center, Raleigh, NC 27699-1598
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
TIP B-5355: Replace Bridge No. 106 on SR 1902 (Dibrell Road) over Wolf Island Creek
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES AT DIFFERENT
SITES)
State: NC County/parish/borough: Ro�k�n9nam Clt�/: Mayfield
Center coordinates of site (lat/long in degree decimal format):
Lat. 36.498460 °N; LOng. 79•541767 °W.
Universal Transverse Mercator:
Name of nearest waterbody: W��f �S�ana creek
Identify (estimate) amount of waters in the review area:
Non-wetland waters:
547 Ilnear fget: 8- 25 range width (ft) and/or acres.
Cowardin Class: R��er�ne
Strgarp F�OW: Perennial
Wetlands: acres.
Cowardin Class: Pa�ustr�ne, Emergent and Palustrine, Forested
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal:
Non-Tidal:
1

E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
� Office (Desk) Determination. Date:
� Field Determination. Date(s):
SUPPORTING DATA. Data reviewed for preliminary JD
(check all that apply - checked items should be included in case file and,
where checked and requested, appropriately reference sources below):
� Maps, plans, plots or plat submitted by or on behalf of the
aj�p�ICall�✓COIISU�tallt: Amec Foster Wheeler
❑✓ Data sheets prepared/submitted by or on behalf of the
appl�nt/consultant.
Office concurs with data sheets/delineation report.
� Office does not concur with data sheets/delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
� USGS NHD data
� USGS 8 and 12 digit HUC maps
❑ U.S. Geological Survey map(s). Cite scale & quad name:
❑ USDA Natural Resources Conservation Service Soil Survey.
Citation:
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
� 100-year Floodplain Elevation is:
(National Geodectic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date): or
� Other (Name & Date):
� Previous determination(s). File no. and date of response letter:
� Other information (please specify):
�

1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide General Permit (NWP) or other general permit verification requiring
"pre-construction notification" (PCN), or requests verification for a non-reporting
NWP or other general permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP or other general permit authorization; (4)
that the applicant can accept a permit authorization and thereby agree to comply
with all the terms and conditions of that permit, including whatever mitigation
requirements the Corps has determined to be necessary; (5) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes any challenge to
such jurisdiction in any administrative or judicial compliance or enforcement
action, or in any administrative appeal or in any Federal court; and (7) whether
the applicant elects to use either an approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Further, an approved JD, a proffered
individual permit (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.

TIP B-5355
This preliminary JD finds that there "may be" waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be
affected by the proposed activity, based on the following information:
IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified bv the Corps and should not be relied upon for
later jurisdictional determinations. „
Signature and date of
Regulatory Project Manager
(REQUIRED)
�
� � IS
Sign re and date of
person requesting pr 'mi JD
(REQUIRED, unless obtaining
the signature is impracticable)

TIP B-5355
Waters of the U.S. Summary Table
Estimated Amount
Site Cowardin of Aquatic Class of Aquatic
Number Latitude Longitude Class Resource in Resource
Review Area
Palustrine, Non-section 10
WA 36.4996 79.5428 Forested �0.1 acre wetland
Palustrine, Non-section 10
WB 36.4981 79.5416 Emergent 0.1 acre wetland
Riverine,
Wolf Island 36.4982 79.5419 Perennial, 200 feet Non-section 10
Creek Unconsolidated stream
Bottom
Riverine,
SA 36.4988 79.5425 Perennial, 347 feet Non-section 10
Unconsolidated stream
Bottom

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ofNaflTp�q VICINITY MAP N County:ROCKINGHAM
yp`` 90�9 NORTHCAROLINADEPARTMENT BRIDGE REPLACEMENT FI Ure
, OF TRANSPORTATION Div: 7 TIP# B-5355 g
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TIP PROJECT B-5355
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amec foster wheeler � PREPARED: Wednesday, June 24, 2015 SOURCE: North Carolina Department of Transportation MAP PROJECTION: NC State Plane (NAD83, GRS1980) �
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Disclaimer: The information contained on this page is taken from aerial mapping, tax mapping, and public records and is NOT to be construed or
used as a survey or'legal description'. Only a licensed professional land surveyor can legally determine precise locations, elevations, length and
direction of a line, and areas.
Parcels
Long PIN: 803000908837 Owner State: NC Deed Book: 1237
Parcel Number: 166871 Owner Zip: 27311 Deed Page: 644-49
Owner ID: 1246489 Deed Acres: 61.15 Deed Year: 2005
Owner Name1: PAGE ELIZABETH J TRUSTEE Fire District: RUFFIN FD Date Sold: 20050401
Owner Address: 581 DIBRELL RD Township: 8 Zoning: RA
Onwer City: PELHAM Land Value: 46533 Year Built: 0
Total Value: 46533
Attributes at point: N: 1001231, E: 1840017
Census Block Groups Precincts Soils
Block Group: 0401003 Name: LINCOLN DSL Name: RnE
Townships
Name: RUFFIN TOWNSHIP
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� '�.'�.�.� '.�j�I � a_ - _�i���: i ����
Rockingham County, NC
Disclaimer: The information contained on this page is taken from aerial mapping, tax mapping, and public records and is NOT to be construed or
used as a survey or'legal description'. Only a licensed professional land surveyor can legally determine precise locations, elevations, length and
direction of a line, and areas.
Parcels
Long PIN:894900190686
Parcel Number: 166587
Owner ID: 1158193
Owner Name1: MCKINNEY WILLIE G
Owner Name2: MCKINNEY LINDA P
OwnerAddress: 942 DIBRELL RD
Onwer City: PELHAM
Census Block Groups
Block Group: 0401003
Townships
Name: RUFFIN TOWNSHIP
init: start
init: done
Owner State: NC
Owner Zip: 27311
Deed Acres: 38.09
Fire District: RUFFIN FD
Township: 8
Land Value: 87368
Improvment Value: 215770
Total Value: 303138
Deed Book: 1124
Deed Page: 1257
Deed Year: 2002
Date Sold: 20021106
Sales Amount: 107000
Zoning: RA
Year Built: 2004
Attributes at oint: N: 1000174, E: 1841156
Precincts Soils
Name: LINCOLN DSL Name: PcD2
Associates, Inc. http://www.andassoc.com
http://arcgis.webgis.net/nc/Rockingham/printable.asp 5/27/2015

Rockingham County, NC Print Map
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Rockingham County, NC
Disclaimer: The information contained on this page is taken from aerial mapping, tax mapping, and public records and is NOT to be construed or
used as a survey or'legal description'. Only a licensed professional land surveyor can legally determine precise locations, elevations, length and
direction of a line. and areas.
Long PIN:894900145493
Parcel Number: 175335
Owner ID: 47711
Owner Name1: OAKHAVEN FARMS INC
Owner Address: 414 PIEDMONT AVE
Onwer City: ROCKY MOUNT
Census Block Groups
Block Group: 0401003
Townships
Name: RUFFIN TOWNSHIP
init: start
init: done
Parcels
Owner State: NC
Owner Zip: 27803-1825
Deed Acres: 1297.15
Fire District: RUFFIN FD
Township: 8
Land Value:2148648
Improvment Value: 556954
Total Value: 2705602
Deed Book: 1388
Deed Page: 835
Deed Year: 2010
Date SoId:20100105
Zoning: RA
Year Built: 1960
Attributes at oint: N: 995831, E: 1841764
Precincts Soils
Name: LINCOLN DSL Name: CdB2
Associates, Inc. http://www.andassoc.com
http://arcgis.webgis.net/nc/Rockingham/printable.asp 5/27/2015

���� �
�.�p �� ���=
NC DW S�reazz� �de�ii�icahon Farm 'Version 4.11
Date: � � "' pro'ectlSite:t�iC:�f' 1
,r/-E''�icP�;Y-� � -'`t"r'� � f'-�
E�aivator: s � Cauniy: �{"C���i�>r ',���,: ��
� , �.��r�
'ia#al Paints: � � � Stream Determination (circle o
Streamisatreastintermitient ��, E hemeral Intermitten Ferenn
if ? 1� or perennia! if>_ 30` �
A. Geomor holo (Subtotal = jb� ) Absent Weak
1 a` Continuity of c�anr�el bed and hank 0 1
2. Sinuosity of c�annel alon� thalweg a 1
3. In-channel structure: ex. r€ffls-pool, step-poal, 0 1
ri le- ool se uence
4. Pariicle size af stream substrate 0 1
5. Acti�elrelict floodpfain 0 1'�
8. Depositianal bars or benches 0 1
7. Recer�t allu�ial deposits 0� 1
$. Headcuts � q ) 1 ,t
9. Grade cantrol 0 0.5 �
10. Natural valley 0 �,�.�
11. Second vr greater order channel i�a = 0
a artifcial ditches are not ra#ed; see discussirns in manual
B. H drolo Sub#otal =
12. Presence of Baseflow 0 1
13. Iron oxidizing bacteria 0 1
14. Leaf litter 1.5 1`
1S. Sediment on plants ordebris 0 [7.5
1fi. Organic debris lines or piles 0 Q.5
'17. Soil-based euidence of high water table? No = 0
C. Biolo Subtatal = '�
'i8. Fibrous roots in streamkaed 3'� 2
99. Rooted vpland piants in streambed 3 2�`
2�. Macrobenthos (note diversity and abundance) 0 �'
21. Aquatic Mallusks 0 i i
22. Fish � � 0.5
23. Cra�sh � 0.5
24. Amphibians 0 .5
25. Algae 0� 0.5
26. Wetland plants ir� streambed FACW =
'perennial streams may also 6e idsntified using other methods. S�e p. 35 of mar�ual,
I�OtBS: ��'�.•f: .5 4 �,�r-- ,✓c.' �ILv.f-Jy-�'-•a;rl ��C� r}. �ft,'r�1.i,k'
Sketch: �`� � � :'v,/�
9�
��SD�
��''�'"��� �'�
_ ��.}���a �i
�'���,� �5�:�}- �i�
:�}-
Latitude: � � �w-9 0� � `�} �
Longitude: `��c�j'�-���'�-'y,
Otf�er
e.g.G7uadlv'ame: �,,f��r1
Maderate
2
2
2
2
2
1
1
.,�.
3
3
3
3
3
3
3
1.5
1.6
Yes �3 `�
0
2� 3
2 3
o.� a
"'1. �.5
� 9.5
Yes �3 �
1
1
2
2
1
1
1
1
OBL � 1.5 Ot�er = 0
0
0
3
3
1.5
1.5
1.5
1.5

USACE AID� D«'Q � T'' ite # {iz�clicate oz� at#ached map}
�--i�� -�' .`J � }--� _
;,�;, ' STI�EAVI QUALITfi'` AS�SESSI��IENT tiVQRKSHEET
Pravide thc foilowing information for thc stream reach under assessment:
1. Applicant's name: f�:�� 1��� 2. Evaluator's name:
3. Date of evaivation:__��? �' 1L�liry �;��-f `� 4. Time of e�aluation:
`�'< f/-�
6�
�. N�me of st�am G�yT ���wsa�c�fl'� �K �r '� 6. River basin• � C`�"�G �'�: �
1�° Lt��.'%�� �t�aa� �� ; , . i
7. Apprc�ximafe �a�na�e ama: G^���t�'�'�� + 8. Str�ani order: ��'����—�'�����L����'�
� fl
9. Length af reach evaluatec�: � t'�� �-+`ti�T" 14. County: /C GC��"I `i�ILe r� r�,�
ll. Site coordinates {if kno�vn)� prefer in decimal de,rees. 12. Subc�ivision nan�e (if ai�y): ��
yqr/ -, `
Latitude f�;r. 3a.8 �2312): -� �i i 1 � ��a Lon�itude {ex. -77.,56611): �7. �� �- l ��"
vlethod location det�rrnined (cirole): GP� Topo Sheet OnhQ (Aerial) P]�otcr/GIS O�ther GIS Other
13, Location of reach undzr e�.^alu tian note nearby roads and landn�arks and attach map identifying stream{s) location):
�,
�'i.`� j.`[�fn•,^r�� . �.e': !.%P�
14, Propos�d �hannel �vork (if any)
15. Recent �veather conditions:
1C. Site canditions at time �fvisi
�i[Vl �DLZ' ►�:I"1
��' `f — �i' `/" .` '�"y.
�.,.
-.�� 1"� � �i�f`!" : Nr t��
17. Tdentify any sp�cial Lvaterway elassifications kno��m
_Trout i14'aters �Outskanding Resource VVaters
_5ection 10
r� ��T C+
C /���
Tidal 44'aters Essential Fisheries Habitat
]�utrient Sensiti�'e V4'aters _tVater Supgly 1�Vatershed (I-IV)
�
1S. is there a pond or lake tocated upstream of the er�alt�atiort paint? YES TO' If yes, estimate the �vater surfac� area:
19. Does cllannel appear on USGS qt�ad map? ES � NO 20. Does channe] appear on LSDA Sail Sun ey? ES � NO
�1. Estimated tvatershed land tise: �° o Residential i% Conunercial _% Industrial %:�gri�ulttEral
J�`�0/a Forested _% C�earec� I Lo;�eci �:' °fo Other (��'��� "����)
22. Bankfull �wadth: `� ��'� ��- I' � 23. Bank hei�ht (from bed to top of bank); �3 ��' '� `��'r��"
24. Channe� slope down center of stream: ��lat (4 to 2°ro) Gentle (2 to �%) _l�laderate (� to 10%} _Stee� (>YO°��)
25. Channel sinuosiry: Scrai�ht t�,�ccasional bends _Frequeiit meandzr Very sinuo��s Brai�ied cl�sannel
Instructions for cainpletion of �ti�orksheet (located on pag� 2): Begin by detenninin, the most appropriate ecore�ion based on
location, terrain, ve�etat'son, strearri classification, etc. �� �ry eharacteristic n�iist be sc�red usine the sar�ie ecore�ion. Assibn points
to each characteristic within the ranae sho�vn for the �eore�ion. Pa�e 3 provides a bri�f description of ho�� to reviesv the
c�ar�cieristics identified in the �W�orksheet. 5cores slaould reflect an overall assessment of the stream reach �inder eva€uatian. If a
characieristic cannot be evaluated due to site csr �veather conditions, enter 0 in tl�e scarin� }�ox and pro��icle an exp�anation i�� th�
commzn� section. �ir'here there are ob�•ious chan�es in khe charaeter nf a stre�m under revie�v (e.g., tl�e stream flotvs fa'om a pasture
into a forest), tk�e stream may be divided into smaller reaches that display more cantinuiry, and a separate fornl used to evaliiate each
reach. The �otal score assi�ned to a stream reach must range betrveen 0 and 140, with � sco�-e of ] 00 repr�serating a stream of the
hi�hest quality.
�— �c�,� ��L�� ���3 ���
Total Scare (from reverse): Comments: L
Evaluator's Sibnaturc ��`� ",^ 1.��� r" � `'
Date � �-
This channel evaluation form is intended to be used nnly as a guide to assist landonrners and environ�nental proiessionals in
gathering the data required b�� the linited Skaies �►rmy Corps of Eneineers to make a preliminary assessment o#' stream
qualit,r'. The tatal scorc resuiting from the compietion of this �orm is subject to �;iSACE approval a►�d daes nat imply a
partic�lar miti�ation ratio or requirement. Farm subj�ct to chars;e—version Ob/0.i. To Comn�ent, please ca11 9 1 9-376-84�1 x 2b.

S1�ii�:Alv1(�UA1.i�1�Y A�S�SSMENT WORI�SHEET
`T�'f � �i�=� � �_,
EC���GI�CIti�PCJI�vT I2..�.'�IC's� :
� ; CH�R:�C""�"�.�[�T�CS ; ��::�3R�
. E'o�st�t :��'�ieclrt�€�nty gi'cruntain ; �
�, . ', , , . . . . . ._. _ . .. , ,
:
Pres�t�cc of fl�r« /�crsistcnt pacsls in s��•e�m y
I i. : �-� ! �.. 4 :'_ 0- � .
(na ilo�v �r satiir�ti7n = �; strat�� �(l�?��.� = rrtaX 1�c�intsi �
�
., '�' �'�•i[�etzti a�pasY ltuni�n cilt��-a#iun �
� -6 (}-� Q-�
��c�,tealsii-e aiteration == 0; no s�tc:r��ti�r� = nla� pt�ia�ts)
Rip�lrian zune .�
� '� p-6 �-=� 0-�
�I {i�c� buffa��- �7;�conti�iiQus. ��icle k�ufFei - m2� noants�J �
I � � E�'itlencc qf nut� ient or cticn��c�[ disch��r+�es ' �
, � ri
, � t3 _ ; p ._ � p _. -;.
, {'ecten;it-e di;c�har�es -� C}; n� discii:�r��es =��1�x pain�s)
E ,� 'i � ' Ge•ound�F•nter cfiscf►�jrge � {3 - ; C� - � (i - '4
E;'�` i � � [no ��3i�clazr��� = 0; sprin =�, seePs; �v�ti�sld�, etc. - max points) � � �
�..� .
� . Presenc� vf' �rl�aecnt tic�oc�ptai❑
I r.W j � �}-,� ()-'� �-7 �l
'� ` � (r�o �7oc�d��l�in = f3; e:�tensi�z f'Ic�odptain = tnaY points}
�
� .`� �ntr•ench�nent l' fta�d�3t�i� access /
�.; : ` (cieepl�� �ntrenciYetl - €l; �r�c��iLi3t f1o�c§i�i� = nztir �oint�l ' � _ � 0 _ � 0 - 2 l
� : P�•csencc e�f ad,jacent ���etlar�ds � ' i �
� 0 6 � �-=� fl-2 /
{n� ��'etizrt�lti - U; iar�e �djacei�t ta�[iand5 = m�t points) � p � � �
, ��:h�►anet sina�sitt� �
9 � � � 0-�1 (J-J
fixtens��-e ct�,inz�eliz�tian = Q; i�atural me��lder = n���x �c�i��ts) '�
r � l � . Se[iirncryt i��pr�t � 5 � � - �} � _ �l 7
j � � (ertznsi� e c�z��crsi�ic�n= 0; iittlL c,�� no se�im�Bic -�11a� oc�»r�ts� _'�
� Size c�r cli�•ersit� �f �hannet bed s��bstrate i -.�
1 f , � �; r� � !) - � (� - �, . �,
� (t�Enc. l�c��n���znc�us O; I�r�z. c�i�.�ers: .izes - max g�z�int5� � � � � � � � --
� � � � � � �
, ,, F�i�icnc� a�f e}�unrreE incisip�tl €�r«�i[Ecnin� � •-'T
; �+ 1 � (due (i� in�:is�ci = {}; sta��le bed �: banks = ���a� �c��nts} � � i � - � � � � , �
`
(""' 13 C't esence of ma,j�r ba�k {ailures � t � Q s � �_ � ��
� 7
{ se�=ece �rc�sic�n �fl: nea erasivn. st<�k�te : ai�ks = rn�x pc�i�7tsg � � �
�' Itpat dcpth anc! clei3sit�° an banks i -
' � i3 . �-; 0-4 � 0-3 �
�, (i�a � ���ble roots = 0; �Ie�ise rac�ts t�lruii�llo«t = i�«:t pc����tsi i : ; -
�%' � V ; . Ia�}pact b� a�a-icul#r�re, ii� eStvek, ar timber �roduetion � -- � ()-- � � l) -- � �
� ��� ��(,ttbsYar�tial in�p�ct �}; no evide��c� �- niax �c�ir7ts) � � � �
' � P3 esence r�f' i~iE't7e-��a�!/rip�le-p�oE co�nple�es �7
, I 6 c� 3 C3 - � 0_ f
i�c7 riftl�5. ri � les �r pac�l� =(�: ��-�!(-€i�s 4lc��cd - n�ax c�i��t�? �
�"' ! n; Hat�itat cample�it�_ �� 6 0- f� �J _ E� �
E•' ': ' flittle c?t• i1c� ha?�itat �: Q: fi-eq��e��t, �farie� ]�abst�ts =�iar �Qi�rts)
� �' �
.�
� � Ganop�� co�°erabe t��er streambe€4 F�
�;'�. I� : t)-; ' t3�-� , ;p_j
,�, ', ( nc, si�a�in, z::�}etati��a = C1: cc�i�tin�tt�iFs ca��c�p� -- �7�ax pt�ints;
� .
Substrate c;jni�c�ici��lne�s
lg : \��' t1--� �-=� __�
{deznly� en�bedciec� = 0: Io�st str��ctti�e - i�iar}
; ?� Pi'esence ut'streain inE•ct•tek��•ates (see pat�� 4) � ,, Q - � � - ; �
� (no et i�ztlee �; c«r�l��on. t�taa��erc�ixs tt� ��s = itiax ��int5}
�
� 3 -, : 1'E•esence of amphibians �
,,,, 3 _1 t)-� 0-� �-4
� ti✓ : � (t10 �i iC��'[14�� �; �l;0it1?Tl(?R, L1lItT1E C'O115 i.�'{��'� - Ti't7X jJl�Il225� �. . .. . �
� `; i _ � �� Presence of �ish � � � . a
� ; ?'' i (j _ � Ct - � � - =a- E�J
�-+ ' � � { nc7 r�s id�n: e � �1;� c�t�imun, �natnerc�u4_����es = ��zax �ai��.�ts)
�
! LvEifez�ce Qf �+�°ilcilife use ! �
� � � �� (i�o : ��id�;�.��. = ��; <���ii2d���i�t ��: icknce =���7,�e paints) � �� 4 - � � �- � � � 0 - � «.J
A� � � � �
, ,._ : . .. �. . . .� ' . . . � . � � , 3 � �W
� ` ` Tt�ta� P�ints P�ssi��it : j �� � aUt� I . I {l(� : _ � � �:
_
, :� �
� . . . ,. . E , _ . .-' -. -; , '�: . .. : �: . .; . ...:>,.. �
TC3T�,L 5�'{)�E t`�tl�u c�t�tc�� un tir4i ��tL�} ::' r"'� ,
_ _ __ , �— �
'�` Tltesz characteristic; are not a�s�ss�d ia� cu��5tai stre<iuis.

C,�.�'�/� ����C�'��
�� �� �.���s
NC DWQ Stream Identification Form Version 4.1.1
�ate: ,�,,�,vckr' �G` �A� ProJectlSite:,f�,��'y�l��%/,'��,�'.>
E�aluator: ,�^' � Count , - �
� � �'-�t�y� Y� �G, c,�C �, �:�; ,v,
7otal Points; Y Strearn �etermination (circ e�i
St>eam is atfeast inf�rmittent �� '� � �p�emeral fntermitten erenr�ial
if_ 19 oroarennial if? 30� .
���� ������
Latisude:.��` r'.�'!�,a��.�.j
7
Longitude; ��' �����
(3ther
e.g. 4uad IVame: �¢� -����,�
A. Geomor hola {Su6total =� I } A�sent Weafc Moderate Str ng
1a� Continuity of channel bed asad bank 0 1 2 3�
2, Sinuosity of channel along t#�alweg 0 1 2 3
3. In-channel structure: sx. riffle-pooi, step-pqol, 0 1 2 �%
ri le- ool se uen�ce
4. Particle size of stream substrate 0 1 2� 3
6. Activelrelict flaodpiain Q 1 2 3
6. Depositio�taC b�rs or benches 0 9 2 3
i. Recer�t allvvia� depasits Q 1 2 3`
8. Headcuts � p "� � .. 2 �
9. Grade control p 0. 4' 1 1.5
10. Natural valley a 0.5 ' i 1.5
11. Second or greater order channel No = 0 Y�s 3
a
ui��i�r.iui �i�a.irua aiu �iu� ineGU� JGG UI.ZI.UJJIVIIJ III.lIlO41UGl
B. H� drolo �ubt�tal = i ��
12. Presence of Baseflow 0 1
13. Iron oxid€zing baeteria 0` 1
'i4. Leaf litter 1.5 � 1
15. Sediment on plants or debris 0 Q.5
16. Organic debris lines or piEes 0 Q.5
17. Soil-based evicience ofi high water ta�le? No = 0
C. Biola (Subtota! = L' �
18. Fibrous roats Pn streambed 3'� 2
19. Rooted upland plants in strearn�ed 3' 2
20. MSCrobenthas (note diversi#y and abundance) Q 1
21. Aquatic Mollusks C1 ` 1
22. Fish q Q.5
23. Cra�sh p p,5
24. Amphibians p p.�
25. Algae R� �.5
2G. Wetland plants in sfrearrEbed FACW =
*perersnial streams rnay also be identifi€d using otF�er methods. 5ee p. 35 of manual,
�O�f;S:
sket��,: �� °� �
it �' �
� , �
41�%���'r��
(�. �" I �
! f �
� u.r'-4'. �4
� �
2 3
0.6 0
1 9 .:
1 1�
Yes 3,
�
0
0
�
i � I
O�L = 1.5 Othe� = 0
0
0
3
3
1.5
1.5
1.5
1.5

" L��AC�
_ f,�,�. _. ..__. __. __�. _ _ __ _�_ �..._.... ..
_ _..#
p# Site # (indic�tc, c�i� attaehed map} j
{ _ ������} �TREAPv1 Q[1ALiTY ASSESS��E��T WORKSMEET
„�„ �
�� � � � �< <
�'r�uvide the follo�vi�i�; inf'armaxiUn for th�trear►i reach u��der assessment:
l. Applicant's n�me: %'� �?��� 2. L��aluat�r's
���`�
�-� _-�
��
-.r�
3. Date of evaluation: ���J �cr� �� �-�'1'�� 4. Tit�ic of Lvalu�tson: �'���
5. t�a�ne ot'str�an�; L�e�F y�s"�u-�r l.� � j"��.�� 6. Ri�-c r�asin: /t �',��2 t e<"�
� L�"` � � i .
i. :����roxin�ai�; drain�gc �rea: ���y� � �`�'�''� �. Strcam orc4cr: .�'�'`� �- � �'
9, Lcnbth aFrcach �v�ituated: ��,.1 �� ��?` I0. [:c�unCv: E� ��'�/�'� �'ttt i�'+
l d. Site coc�rdinates {if�kno���n): �eefer in dr:c�snal degrees. 12. S�ibclivi�iun name (iian}�): `�'"'
+!. i.� ���' 1 .y,/ %'�
I,atitu�ie(c�.3�.872312�: ,�`�� 4� 1 L�� Lcmgitude(c.�. -77.Si65II�: ��,�,_._�7'l�� I
Method lacatit�n cleten��incc{ (circle): CipS � Tope� Sheet Ortho I:1crill} ��15ot��;G1S Qthcr Ci1S (3ther
13, Locakion t�f reach uncfer e� aluat�on nntc ncarb�r roatis �ttd landi�iarks and attach map identif�ing streat�t{s) location):
�� ,
�s'-G �. {?�"e,'� r� ,� .'*7� si a� :i�+e -
14. Prc�posed ch�ailit�l work (if any}: �E�N. �►� �° �✓'"
l5. Recent �vcalher
16. Si�e co€i�itions <
17. [dentiiy ar�y speciai wate�zvay classifications k��a��°n; _�eetioai 14� �Tidal Watcrs ��.Ssential Fis[�eraes t-�abitat
_Trcrut �'Vatcrs �Outstandit�g €tesource 1Naters _ Nutricnt Sc,nsitit°e �h'aters 4i�'atc►� Supply Walershe�i (1-I�')
1$. [s there a pond c�r lake lc�cated upstreatr� c�Fthe evalu�atiot� po�nt° l'�.S �lO �lt ycs, estir�3ate tl�e w�ati:r 5urfaee arca;
�,
i�. �ocs channel appea�' on USGS q��ad map? YES I'JO 20. Dnes ch�tnnel appear on USDA Soii 5urvey? '�'�, N�
21. Estimated watershed lai�d tase� °�o Ftesic�e��kial °% Cotnn�ercia€ "� lndustrial °�o.�griculiural
�'1 n,o Fc�restecl "4� Glear�d I Log�ed ��`'°�o Other (�eT�Z jtJ���/ )
� —
j 1 f � f -, ,,:�-.
22. �3nnkCull r� idth: �- i��� �- 23. Sank heighl (frain bed t� top oC bank): �'� .��'"`" �
2�. Channel slape da«�n center oi� stream: ,� Flat (0 tc� 2°%) _Gee�tl� (? to 4°'01 �„Moder�te {=� ta 10"�0) _Sleep (>� 0%)
25. {`l�an�le[ si�iuosity: Slraigltt �Occasional bends _Frequent mcancler �Very sintEous �E3raided ch�nnel
I�tstructions far e�mpletion of ►vorksheet (located on pa5� �): E3e�iai by cietcrEnii�ing the m�s1 a]j�ro]ariatc ecorc�ion basc:d on
localic�n, terrain, ve�etatio��, strcafn classification, etc. [;very cl:aracteristie must bc scored using the same ecore�it�n. Assig�i poinis
to caeh el�aracteristic t}•ithin the range shotvn f�r tl�e ccaregiau. Page 3 y�rovid�s a bricf clescription c�f ho�v to rev�e«° die
cl��r��i�ristics identificd in thc �vc�rkshcct. Seores s3�o�i�ci rcfl�ct an o��erall �sscssn7c��l at ti�e strearn reach under cvaluation. !f a
characteristie c�ttnot be evaluated due to site or wea�hen- cc��ditions, cnter �1 in the scoring box a€�ci pr��-icfe an explar�atic�n in the
cortnn�:ut szction. Where ihere are abvivus ihanges itt tt�c characlar c�f a streaan ur�der revie��� (e.g,, the slrea�u il�e�,�s frUm a past��re
i�t[o a forest). the stroam mtiy bc t�i�ided into sn�aller reaches [l�at ctisplay n3ure eontin�tity, ancl a sepamate %nn used to e��atuate e�r;h
rc�c.h. `]'he total score �rssigned to a stream reach ntusi ranoe be4�vecn 0�nd 1 a0, with a score of 10� representiEig a stre�.tEl� vf [l�e
highcst c��iality.
n .'J .+"
Total Seare (frun� re��erse): � � Cornments: � �J�� � �Jg � r r �� ~ y
Er•aluator's,5ignaturc ���t� �„ l��{ Date ����j�
This channei e�:�luation form es iotended to be used �nly as a guide tu assisf landowners aad en��irunmental professiaitials in
�atherin� the data required by ttie United States Arm�� Carps oi" En�ineers to na�ke a preliminar}� assessment of stream
qualitF^. Tiye totai sccrre resaitti�ig from the completian of' this fornz is subjeet t� LSACE approva! and does nr�t implr� a
pai�ticular mi#igatiun rati� or requi�•ement. Fortra subject ta cE��nge - ti�ersio[1 UtS,`U3. To � omment, pl�asc call 919-87t>-8441 x 2�.

�i�'o%,s%� C�1�-
���, ����� STR�AM QUA��TY�.SSESSMEl�TT VyqRKSHE�T
� � . ; . �. �� �G�I�����'Q��d:� ��Z�'���� � ����
��� �� � ��*���TE�IST�C`�;' � � �� �
�� � � � �s � �:'� E � �it�v�it �:�� ��tou��aEr� ���
`' E i'reser�ce pf �o��� 1 persisrenE pools in stream -�
,� j 1 � � (? T � t�:�— 4 �.= 5�
(r�o flo�� or'sati�rat�on -:'t7, s€ran� t�aw ��nax di€�ks
. � � ,� Ev�deu��e o� }�asf �u�n�#� al�erat�a�n � � - � � 0; ,— 5 ' � � (} ��— 5 :
(extensive alteration = �: n� atteratioi� = t��a� oints}
Riparian zo1�e
� ,_ � � �� ' � � ; �.: � . � �� � .
: . � (na �nffer = 0; c€�r�t��iroi�s,"�vi�i� i�uffzr = rnax � �ints � ' � � �
EvicFence of nutrier�t o�- ehemicaC t�ischarges
4 : �� — , �_�� ����." ����,��
extensi4�c ciisctzarvcs = 0; �io tiischarCres = max` oints)
� Gzound�iacer'dischar¢e ��
� ._ � � � � �. qT�
nc� di�c�arae =(?, s z�iz� s, see s, «etlands, etc. — n�ax oints ,
� Prese��ce o£ adjaeent a�aodptair�
� 6 0—� t3;-4 (�-2
�
no f�€�as3 lair� — U; e�tensive floc�d lain = znax tsia�ts
� 7 � Entrenci�ment�i ffnadpl�izz aecess ; � : � � � � 3 p� 4 Q — `�
�" dee E � er,t�ef�checl= {�: fire uent �t�o�dar�� = max � oints) � ; �j
Presenee of ad,�aeent fvet�ai�tis
� , �.. : � �-� t��_A . � ,� pT� .
{no «-it�anris = (�; �a�-�e acijaeent iset[an�ls = nlas t�ints
� q . . �, ��Channel sinu��i�► , . �� ' _ � � j �
�{extensik� t;liannelization-�0; natural n�ear�der-= max ints)` � ��— � � �— �
, Sed'au�ent input
1� :. ` � p S �� , � p�-� � � `.4 .
(exte�sivede c�sitio��—.U;litil�orncs'sedin�eni=ma;c oi�its)'
Si�a .� �liv�er�ity of ehannel bid iubstrafe �
l i : r � 4� c l�.T �# . _ ._ . (} S ,
��nc, hcirraoz��nc�u; —1?; lac }�, dz��;rsc sizes'= rz�.ax oints �
mm �; �viilence af ch�Einei incision or iridening .'� _
1 ' � €� � � t}: : 4 . f�_= :5
� dee 1� inc�sed'= {i; siable bed & banks = i��ax t�i:ifs
�; l� ' Presence of major 6an�: faifures �_ 5 0'= 5 0,- 5•
� � s��•cre.��i�io�3 = �; no cr�sion, stabl� banks -�- n�ax' �in�i � � `
�-
..�, �
� ; , R.00t de�th and, densiry an banks '
� 1� � na� viszbie ro�ts = tl; dens� roots��thrn� haut = n�ax� osnts) �� � 3� ` Q�-� 4 �l - 5
E-�
� �� r�Pac# by abricui��rr�, layzstock, ar timber prrQ�iuction �� - � r � �
l� � � ��� 0=4 O—S�
� {substarstia� ir�� act—U; zao evAdence—'ma� c�i��ts
F �'resenee of rifif�e-p€��►1lripple-perol ec�m�le�es
�
� 16 ,'� , . Ci-3 '. 0-5 �-5
. t.ne� ri£fl::s'ri fes ar jouls — t7: ��e(i-c€e��elo ed = n�ax o�nts - ,:
�� Habitat complexiiy
� 17 � - � . Q—& � 4-6 �-. :� ��-�.
(Iittle ar no h�bitat —(?; fre ' uent, ��araed habstats � inax ants
��annpy cavera�e over strea�nl��d
i R j�o s��a �ie�<� ve�etatinn = 0: cantira€�ous canc, = niax Qints) �—� � �� (} ��
� 5ubstrate ernbeddedness ; � �
�9 �� � � (c�ee i r en�b�cideci=t�, loose �siruct�re = ina�) Nr�� 0- 4 � �.�- 4
,� �resei�ce �t'-strea��i �n�er.te�iratEs {�;ee �age ��) � '� � �
` 2I} : � {� — 4 O �_ .� ` p �� 5
�
r�a evfdcnce-- �i, c�mn�d�i, nunlerous tv es -- at�ax` cri�ts , ; ;
� "
{ � � ��•�sence of a�nphibians
�. � � � .; �l � ` � � €�:— 4 0 ; 4
�� � no cvicicncc �€7;� co3�tnan� iiuln�mi4s tv. �s — n�ai� �ints)
'"" Presence af f sFi
� ; ? � ' � � D �. � � 6=-� 4 ` ° � t} = 4
� i l. no e��ide�ce — Q;��cor��T��n; mun�roiis �v es -- n�a�: �� oints) -' � € ' _ : < : �. : �
�� � ' � �� ' Evii�ence �of wiidti% �se � � �� � ` � � � � � � � : . : � � �_ � . �
�i
na e�-�s1�.nce — f�: abun�iant c��icicncc = max aints
' �'vtal E'Q�n�s, �t�ssil�t� ' ' ° :l f�Q ; � 1��i J �. . IflQ '. :
, ` T[��'�;L SC(}�: [�i�t�,ente� �� first �a���� . , `
'� Thcse characteristics are not assessed in coastal streams.
�
�
��
�/'
�
, �,
�
�
f
CV��
� `� 1s
!

WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont Wetland WA
Wetland side
Project/Site: Bridge B5355 City/Co.: Rockingham County Sampling Date: 4-Feb-15
Applicant/Owner: NCDOT State: NC Sampling Point: WDA-1 (Wetl)
Investigator(s): James Cutler, PWS Section, Township, Range:
Landform: (hillslope, terrace, etc.) bottomland Local Relief : adjacent hillslope Slope (%): 0
Subregion(LRR/MLRA P/136 Lat: 36.4996 Long: 79.5428 Datum:
Soil Map Unit Name: Codorus loam, 0 to 2% slopes, frequently flooded NWI Classification: none
Are climatic/hydrologic conditions on the site typical for this time of year? � Yes ❑ No (If no, explain in Remarks.)
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ significantly disturbed? Are "Normal Circumstances" present? � Yes ❑ No
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS - Attach site map showinq sam
Hydrophytic Vegetation Present? Yes 0 No ❑
Hydric Soil Present? Yes 0 No ❑
Wetland Hydrology Present? Yes 0 No ❑
Remarks
Wetland area appears to be an old oxbow.
HYDROLOGY
nt locations, transects, important features, etc.
Is the Sampled Area
within a wetland? Yes 0 No ❑
Wetland Hydrology Indicators: Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required; check all that apply): ❑ Surface Soil Cracks (B6)
0 Surface Water (A1) ❑ True Aquatic Plants (B14) ❑ Sparsely Vegetated Concave Surface (B8)
0 High Water Table (A2) ❑ Hydrogen Sulfide Odor (C1) ❑ Drainage Patterns (610)
0 Saturation (A3) ❑ Oxidized Rhizospheres on Living Roots (C3) ❑ Moss Trim Lines (616)
❑ Water Marks (B1) ❑ 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 (63) ❑ Thin Much Surface (C7) ❑ Saturation Visible on Aerial Imagery (C9)
❑ Algal Mat or Crust (B4) ❑ Other (Explain in Remarks) ❑ Stunted or Stressed Plants (D1)
❑ Iron Deposits (B5) ❑ Geomorphic Position (D2)
� Inundation Visible on Aerial Imagery (B7) ❑ Shallow Aquitard (D3)
0 Water-Stained Leaves (B9) ❑ Microtopographic Relief (D4)
� Aquatic Fauna (B13) � FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? 0 Yes ❑ No Depth (inches): 0
Water Table Present? ❑� Yes ❑ No Depth (inches): 0
Saturation Present? �Yes ❑ No Depth (inches): 0 Wetland Hydrology Present? � Yes ❑ No
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants. Bridge 65355 Sampling Point: WDA-1 (Wetl)
Absolute Dominant Indicator pominance Test Worksheet:
Tree Stratum (Plot size: 30ft radius) % Cover Species? Status Number of Dominant Species
1. Fraxinus pennsylvanica 10 Y FACW That Are OBL, FACW, or FAC: 3 (A)
2. Total Number of Dominant
3. Species Across All Strata: 3 (B)
4. Percent of Dominant Species
5. That Are OBL, FACW, or FAC: 100% (A/B)
6.
7. Prevalence Index worksheet:
8. Total % Cover of: Multiply
10 = Total Cover OBL species 0 x 1= 0
50% of total cover: 5 20% of total cover: 2 FACW species 20 x 2= 40
a lin /Shrub Stratum (Plot size: 30ft radius) FAC species 0 x 3= 0
1. Fraxinus pennsylvanica 5 Y FACW FACU species 0 x 4= 0
2. UPL species 0 x 5= 0
3. Column Totals: 20 (A) 40 (B)
4. Prevalence Index = B/A = 2.0
5.
6. Hydrophytic Vegetation Indicators:
7. � Rapid Test for Hydrophytic Vegetation
8. � Dominance Test is > 50%
9. � Prevalence Index is <_ 3.0'
10. � Morphological Adaptations1 (Provide supporting
5 = Total Cover data in Remarks or on a separate sheet
50% of total cover: 2.5 20% of total cover: 1 � Problematic Hydrophytic Vegetation' (Explain)
Herb Stratum (Plot size: 30ft radius)
1. Carex sp. 5 Y FACW � Indicators of hydric soil and wetland hydrology must
2. be present, unless disturbed or problematic
3. Definitions of Four Vegetation Strata:
4.
5� Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
6� more in diameter at breast height (DBH), regardless of
7. height.
8.
9• Sapling/Shrub - Woody plants, excluding vines, less
10. than 3 in. DBH and greater than 3.28 ft (1 m) tall.
11.
12. Herb - All herbaceous (non-woody) plants, regardless of
5 = Total Cover size, and woody plants less than 3.28 ft tall.
50% of total cover: 2.5 20% of total cover: 1
Woodv Vine Stratum (Plot size: 30ft radius) Woody Vines - All woody vines greater than 3.28 ft in height.
1.
2.
3.
4.
5. Hydrophytic
6. Vegetation Yes 0 No ❑
0 = Total Cover Present?
50% of total cover: 0 20% of total cover: 0
Remarks: (Include photo numbers here or on a separate sheet.)
ERDC/CRREL 2014 Regional Wetland Plant List (Eastern Mountains and Piedmont) used for indicator status.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL Bridge B5355 Sampling Point: WDA-1 (Wetl)
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators).
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type� LocZ Texture Remarks
0- 4 10YR4/2 70 10YR4/4 30 D M si cl loam
4- 8 10YR4/4 cl loam
C= Concentration, D= depletion, RM = Reduced Matrix, MS = Masked Sand Grains
ydric Soil Indicators:
❑ Histosol (A1)
❑ 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 Material (S1)
(LRR N, MLRA 747, 148)
❑ Sandy Gleyed Matrix (S4)
❑ Sandy Redox (S4)
I—I Stripped Matrix (S5)
estrictive Layer (if observed):
Type:
Depth (inches):
❑
❑
❑
❑
❑�
❑
❑
❑
❑
❑
❑
❑
`Location: PL = Pore Lining, M= Matrix
Indicators for Problematic Hydric Soils3:
Dark Surface (S7) ❑ 2 cm Muck (A10) (MLRA 147)
Polyvalue Below Surface (S8) (MLRA 147, 748) ❑ Coatal Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 748) (MLRA 147, 748)
Loamy Gleyed Matrix (F2) ❑ Piedmont Floodplain Soils (F19)
Depleted Matrix (F3) (MLRA 136, 747)
Redox Dark Surface (F6) ❑ Very Shallow Dark Surface (TF12)
Depleted Dark Surface (F7) ❑ Other (Explain in Remarks)
Redox Depressions (FS)
Iron-Manganese Masses (F12) (LRR N, MLRA 136)
Umbric Surface (F13) (MLRA 136, 722)
Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 747)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes � No ❑
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont Wetland WA
Upland side
Project/Site: Bridge B5355 City/Co.: Rockingham County Sampling Date: 4-Feb-15
Applicant/Owner: NCDOT State: NC Sampling Point: WDA-1 (Upl)
Investigator(s): James Cutler, PWS Section, Township, Range:
Landform: (hillslope, terrace, etc.) hillslope Local Relief : hill and valley Slope (%): <12
Subregion(LRR/MLRA P/136 Lat: 36.4996 Long: 79.5428 Datum:
Soil Map Unit Name: NWI Classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? � Yes ❑ No (If no, explain in Remarks.)
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ significantly disturbed? Are "Normal Circumstances" present? � Yes ❑ No
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS - Attach site map showinq sam
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks
HYDROLOGY
Yes 0 No ❑
Yes ❑ No 0
Yes ❑ No 0
nt locations, transects, important features, etc.
Is the Sampled Area
within a wetland? Yes ❑ No �
Wetland Hydrology Indicators: Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required; check all that apply): ❑ Surface Soil Cracks (B6)
❑ Surface Water (A1) ❑ True Aquatic Plants (B14) ❑ Sparsely Vegetated Concave Surface (B8)
❑ High Water Table (A2) ❑ Hydrogen Sulfide Odor (C1) ❑ Drainage Patterns (610)
❑ Saturation (A3) ❑ Oxidized Rhizospheres on Living Roots (C3) ❑ Moss Trim Lines (616)
❑ Water Marks (B1) ❑ 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 (63) ❑ Thin Much Surface (C7) ❑ Saturation Visible on Aerial Imagery (C9)
❑ Algal Mat or Crust (B4) ❑ Other (Explain in Remarks) ❑ Stunted or Stressed Plants (D1)
❑ Iron Deposits (B5) ❑ Geomorphic Position (D2)
❑ Inundation Visible on Aerial Imagery (B7) ❑ Shallow Aquitard (D3)
❑ Water-Stained Leaves (B9) ❑ Microtopographic Relief (D4)
� Aquatic Fauna (B13) � FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? ❑ Yes 0 No Depth (inches):
WaterTable Present? ❑Yes ❑� No Depth (inches):
Saturation Present? ❑Yes � No Depth (inches): Wetland Hydrology Present? ❑ Yes � No
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants. Bridge 65355 Sampling Point: WDA-1 (Upl)
Absolute Dominant Indicator pominance Test Worksheet:
Tree Stratum (Plot size: 30ft radius) % Cover Species? Status Number of Dominant Species
1. Fagus grandifolia 20 Y FACU That Are OBL, FACW, or FAC: 4 (A)
2. Total Number of Dominant
3. Species Across All Strata: 6 (B)
4. Percent of Dominant Species
5. That Are OBL, FACW, or FAC: 67% (A/B)
6.
7. Prevalence Index worksheet:
8. Total % Cover of: Multiply
20 = Total Cover OBL species 0 x 1= 0
50% of total cover: 10 20% of total cover: 4 FACW species 0 x 2= 0
a lin /Shrub Stratum (Plot size: 30ft radius) FAC species 55 x 3= 165
1. Liquidambar styraciflua 30 Y FAC FACU species 30 x 4= 120
2. Fagus grandifolia 10 Y FACU UPL species 0 x 5= 0
3. Column Totals: 85 (A) 285 (B)
4. Prevalence Index = B/A = 3.4
5.
6. Hydrophytic Vegetation Indicators:
7. � Rapid Test for Hydrophytic Vegetation
8. � Dominance Test is > 50%
9. � Prevalence Index is <_ 3.0'
10. � Morphological Adaptations1 (Provide supporting
40 = Total Cover data in Remarks or on a separate sheet
50% of total cover: 20 20% of total cover: 8 ❑ Problematic Hydrophytic Vegetation' (Explain)
Herb Stratum (Plot size: 30ft radius)
1. Lonicera japonica 10 Y FAC ' Indicators of hydric soil and wetland hydrology must
2. Panicum sp. 10 Y FAC be present, unless disturbed or problematic
3. Definitions of Four Vegetation Strata:
4.
5� Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
6� more in diameter at breast height (DBH), regardless of
7. height.
8.
9• Sapling/Shrub - Woody plants, excluding vines, less
10. than 3 in. DBH and greater than 3.28 ft (1 m) tall.
11.
12. Herb - All herbaceous (non-woody) plants, regardless of
20 = Total Cover size, and woody plants less than 3.28 ft tall.
50% of total cover: 10 20% of total cover: 4
Woodv Vine Stratum (Plot size: 30ft radius) Woody Vines - All woody vines greater than 3.28 ft in height.
1. Smilax rotundifolia 5 Y FAC
2.
3.
4.
5. Hydrophytic
6. Vegetation Yes 0 No ❑
5 = Total Cover Present?
50% of total cover: 2.5 20% of total cover: 1
Remarks: (Include photo numbers here or on a separate sheet.)
ERDC/CRREL 2014 Regional Wetland Plant List (Eastern Mountains and Piedmont) used for indicator status.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL Bridge B5355 Sampling Point: WDA-1 (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� LocZ Texture Remarks
0- 12 10YR4/6 100 cl loam
C= Concentration, D= depletion, RM = Reduced Matrix, MS = Masked Sand Grains
ydric Soil Indicators:
❑ Histosol (A1)
❑ 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 Material (S1)
(LRR N, MLRA 747, 148)
❑ Sandy Gleyed Matrix (S4)
❑ Sandy Redox (S4)
I—I Stripped Matrix (S5)
estrictive Layer (if observed):
Type:
Depth (inches):
■
■
■
■
■
■
■
■
■
■
■
�',
`Location: PL = Pore Lining, M= Matrix
Indicators for Problematic Hydric Soils3:
Dark Surface (S7) ❑ 2 cm Muck (A10) (MLRA 147)
Polyvalue Below Surface (S8) (MLRA 147, 748) ❑ Coatal Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 748) (MLRA 147, 748)
Loamy Gleyed Matrix (F2) ❑ Piedmont Floodplain Soils (F19)
Depleted Matrix (F3) (MLRA 136, 747)
Redox Dark Surface (F6) ❑ Very Shallow Dark Surface (TF12)
Depleted Dark Surface (F7) ❑ Other (Explain in Remarks)
Redox Depressions (FS)
Iron-Manganese Masses (F12) (LRR N, MLRA 136)
Umbric Surface (F13) (MLRA 136, 722)
Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 747)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes ❑ No �
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont Wetland WB
Wetland side
Project/Site: Bridge B5355 City/Co.: Rockingham County Sampling Date: 4-Feb-15
Applicant/Owner: NCDOT State: NC Sampling Point: WJA-2 (Wetl)
Investigator(s): James Cutler, PWS Section, Township, Range:
Landform: (hillslope, terrace, etc.) bottomland Local Relief : none Slope (%): 0
Subregion(LRR/MLRA P/136 Lat: 36.4981 Long: 79.5416 Datum:
Soil Map Unit Name: Codorus loam, 0 to 2% slopes, frequently flooded NWI Classification: none
Are climatic/hydrologic conditions on the site typical for this time of year? � Yes ❑ No (If no, explain in Remarks.)
Are Vegetation 0 , Soil 0 , or Hydrology � significantly disturbed? Are "Normal Circumstances" present? ❑ Yes � No
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS - Attach site map showi
Hydrophytic Vegetation Present? Yes 0 No ❑
Hydric Soil Present? Yes 0 No ❑
Wetland Hydrology Present? Yes 0 No ❑
Remarks Herbaceous wetland; most likely historically fores
HYDROLOGY
sampling point locations, transects, imp
Is the Sampled Area
within a wetland? Yes 0
d, but converted to agriculture land use
features, etc.
No ❑
Wetland Hydrology Indicators: Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required; check all that apply): ❑ Surface Soil Cracks (B6)
❑ Surface Water (A1) ❑ True Aquatic Plants (B14) ❑ Sparsely Vegetated Concave Surface (B8)
❑� High Water Table (A2) ❑ Hydrogen Sulfide Odor (C1) ❑ Drainage Patterns (610)
❑� Saturation (A3) ❑ Oxidized Rhizospheres on Living Roots (C3) ❑ Moss Trim Lines (616)
❑ Water Marks (B1) ❑ 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 (63) ❑ Thin Much Surface (C7) ❑ Saturation Visible on Aerial Imagery (C9)
❑ Algal Mat or Crust (B4) ❑ Other (Explain in Remarks) ❑ Stunted or Stressed Plants (D1)
❑ Iron Deposits (B5) ❑ Geomorphic Position (D2)
❑ Inundation Visible on Aerial Imagery (B7) ❑ Shallow Aquitard (D3)
❑ Water-Stained Leaves (B9) ❑ Microtopographic Relief (D4)
� Aquatic Fauna (B13) � FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? ❑ Yes 0 No Depth (inches):
Water Table Present? ❑� Yes ❑ No Depth (inches): 6
Saturation Present? �Yes ❑ No Depth (inches): 0 Wetland Hydrology Present? � Yes ❑ No
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants. Bridge 65355 Sampling Point: WJA-2 (Wetl)
Absolute Dominant Indicator pominance Test Worksheet:
Tree Stratum (Plot size: 30ft radius) % Cover Species? Status Number of Dominant Species
�_ That Are OBL, FACW, or FAC: 2 �q�
2. Total Number of Dominant
3. Species Across All Strata: 2 (B)
4. Percent of Dominant Species
5. That Are OBL, FACW, or FAC: 100% (A/B)
6.
7. Prevalence Index worksheet:
8. Total % Cover of: Multiply
0 = Total Cover OBL species 0 x 1= 0
50% of total cover: 0 20% of total cover: 0 FACW species 50 x 2= 100
a lin /Shrub Stratum (Plot size: 30ft radius) FAC species 30 x 3= 90
1. FACU species 0 x 4= 0
2. UPL species 0 x 5= 0
3. Column Totals: 80 (A) 190 (B)
4. Prevalence Index = B/A = 2.4
5.
6. Hydrophytic Vegetation Indicators:
7. � Rapid Test for Hydrophytic Vegetation
8. � Dominance Test is > 50%
9. � Prevalence Index is <_ 3.0'
10. � Morphological Adaptations1 (Provide supporting
0 = Total Cover data in Remarks or on a separate sheet
50% of total cover: 0 20% of total cover: 0 ❑ Problematic Hydrophytic Vegetation' (Explain)
Herb Stratum (Plot size: 30ft radius)
1. Juncus effusus 50 Y FACW � Indicators of hydric soil and wetland hydrology must
2. Panicum sp. 30 Y FAC be present, unless disturbed or problematic
3. Definitions of Four Vegetation Strata:
4.
5� Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
6� more in diameter at breast height (DBH), regardless of
7. height.
8.
9• Sapling/Shrub - Woody plants, excluding vines, less
10. than 3 in. DBH and greater than 3.28 ft (1 m) tall.
11.
12. Herb - All herbaceous (non-woody) plants, regardless of
80 = Total Cover size, and woody plants less than 3.28 ft tall.
50% of total cover: 40 20% of total cover: 16
Woodv Vine Stratum (Plot size: 30ft radius) Woody Vines - All woody vines greater than 3.28 ft in height.
1.
2.
3.
4.
5. Hydrophytic
6. Vegetation Yes 0 No ❑
0 = Total Cover Present?
50% of total cover: 0 20% of total cover: 0
Remarks: (Include photo numbers here or on a separate sheet.)
ERDC/CRREL 2014 Regional Wetland Plant List (Eastern Mountains and Piedmont) used for indicator status.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL Bridge B5355 Sampling Point: WJA-2 (Wetl)
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators).
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type� LocZ Texture Remarks
0- 8 10YR4/2 60 10YR4/4 40 D M si cl loam
C= Concentration, D= depletion, RM = Reduced Matrix, MS = Masked Sand Grains
ydric Soil Indicators:
❑ Histosol (A1)
❑ 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 Material (S1)
(LRR N, MLRA 747, 148)
❑ Sandy Gleyed Matrix (S4)
❑ Sandy Redox (S4)
I—I Stripped Matrix (S5)
estrictive Layer (if observed):
Type:
Depth (inches):
❑
❑
❑
❑
❑�
❑
❑
❑
❑
❑
❑
❑
`Location: PL = Pore Lining, M= Matrix
Indicators for Problematic Hydric Soils3:
Dark Surface (S7) ❑ 2 cm Muck (A10) (MLRA 147)
Polyvalue Below Surface (S8) (MLRA 147, 748) ❑ Coatal Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 748) (MLRA 147, 748)
Loamy Gleyed Matrix (F2) ❑ Piedmont Floodplain Soils (F19)
Depleted Matrix (F3) (MLRA 136, 747)
Redox Dark Surface (F6) ❑ Very Shallow Dark Surface (TF12)
Depleted Dark Surface (F7) ❑ Other (Explain in Remarks)
Redox Depressions (FS)
Iron-Manganese Masses (F12) (LRR N, MLRA 136)
Umbric Surface (F13) (MLRA 136, 722)
Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 747)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes � No ❑
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont Wetland WB
Upland side
Project/Site: Bridge B5355 City/Co.: Rockingham County Sampling Date: 4-Feb-15
Applicant/Owner: NCDOT State: NC Sampling Point: WJA-2 (Upl)
Investigator(s): James Cutler, PWS Section, Township, Range:
Landform: (hillslope, terrace, etc.) bottomland Local Relief : none Slope (%): 0
Subregion(LRR/MLRA P/136 Lat: 36.4981 Long: 79.5416 Datum:
Soil Map Unit Name: NWI Classification: N/A
Are climatic/hydrologic conditions on the site typical for this time of year? � Yes ❑ No (If no, explain in Remarks.)
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ significantly disturbed? Are "Normal Circumstances" present? � Yes ❑ No
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS - Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks Open agricultural fielc
HYDROLOGY
Yes ❑ No 0 Is the Sampled Area
Yes ❑ No 0 within a wetland? Yes ❑ No �
Yes ❑ No 0
Wetland Hydrology Indicators: Secondary Indicators (minimum of two required)
Primary Indicators (minimum of one is required; check all that apply): ❑ Surface Soil Cracks (B6)
❑ Surface Water (A1) ❑ True Aquatic Plants (B14) ❑ Sparsely Vegetated Concave Surface (B8)
❑ High Water Table (A2) ❑ Hydrogen Sulfide Odor (C1) ❑ Drainage Patterns (610)
❑ Saturation (A3) ❑ Oxidized Rhizospheres on Living Roots (C3) ❑ Moss Trim Lines (616)
❑ Water Marks (B1) ❑ 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 (63) ❑ Thin Much Surface (C7) ❑ Saturation Visible on Aerial Imagery (C9)
❑ Algal Mat or Crust (B4) ❑ Other (Explain in Remarks) ❑ Stunted or Stressed Plants (D1)
❑ Iron Deposits (B5) ❑ Geomorphic Position (D2)
❑ Inundation Visible on Aerial Imagery (B7) ❑ Shallow Aquitard (D3)
❑ Water-Stained Leaves (B9) ❑ Microtopographic Relief (D4)
� Aquatic Fauna (B13) � FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? ❑ Yes 0 No Depth (inches):
WaterTable Present? ❑Yes ❑� No Depth (inches):
Saturation Present? ❑Yes � No Depth (inches): Wetland Hydrology Present? ❑ Yes � No
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants. Bridge 65355 Sampling Point: WJA-2 (Upl)
Absolute Dominant Indicator pominance Test Worksheet:
Tree Stratum (Plot size: 30ft radius) % Cover Species? Status Number of Dominant Species
�_ That Are OBL, FACW, or FAC: 1 (A)
2. Total Number of Dominant
3. Species Across All Strata: 2 (B)
4. Percent of Dominant Species
5. That Are OBL, FACW, or FAC: 50% (A/B)
6.
7. Prevalence Index worksheet:
8. Total % Cover of: Multiply
0 = Total Cover OBL species 0 x 1= 0
50% of total cover: 0 20% of total cover: 0 FACW species 0 x 2= 0
a lin /Shrub Stratum (Plot size: 30ft radius) FAC species 30 x 3= 90
1. FACU species 30 x 4= 120
2. UPL species 0 x 5= 0
3. Column Totals: 60 (A) 210 (B)
4. Prevalence Index = B/A = 3.5
5.
6. Hydrophytic Vegetation Indicators:
7. � Rapid Test for Hydrophytic Vegetation
8. � Dominance Test is > 50%
9. � Prevalence Index is <_ 3.0'
10. � Morphological Adaptations1 (Provide supporting
0 = Total Cover data in Remarks or on a separate sheet
50% of total cover: 0 20% of total cover: 0 ❑ Problematic Hydrophytic Vegetation' (Explain)
Herb Stratum (Plot size: 30ft radius)
1. Panicum sp. 30 Y FAC � Indicators of hydric soil and wetland hydrology must
2. Paspalum notatum 30 Y FACU be present, unless disturbed or problematic
3. Definitions of Four Vegetation Strata:
4.
5� Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
6� more in diameter at breast height (DBH), regardless of
7. height.
8.
9• Sapling/Shrub - Woody plants, excluding vines, less
10. than 3 in. DBH and greater than 3.28 ft (1 m) tall.
11.
12. Herb - All herbaceous (non-woody) plants, regardless of
60 = Total Cover size, and woody plants less than 3.28 ft tall.
50% of total cover: 30 20% of total cover: 12
Woodv Vine Stratum (Plot size: 30ft radius) Woody Vines - All woody vines greater than 3.28 ft in height.
1.
2.
3.
4.
5. Hydrophytic
6. Vegetation Yes ❑ No �
0 = Total Cover Present?
50% of total cover: 0 20% of total cover: 0
Remarks: (Include photo numbers here or on a separate sheet.)
ERDC/CRREL 2014 Regional Wetland Plant List (Eastern Mountains and Piedmont) used for indicator status.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL Bridge B5355 Sampling Point: WJA-2 (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� LocZ Texture Remarks
0- 12 10YR4/6 100 cl loam
C= Concentration, D= depletion, RM = Reduced Matrix, MS = Masked Sand Grains
ydric Soil Indicators:
❑ Histosol (A1)
❑ 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 Material (S1)
(LRR N, MLRA 747, 148)
❑ Sandy Gleyed Matrix (S4)
❑ Sandy Redox (S4)
I—I Stripped Matrix (S5)
estrictive Layer (if observed):
Type:
Depth (inches):
■
■
■
■
■
■
■
■
■
■
■
�',
`Location: PL = Pore Lining, M= Matrix
Indicators for Problematic Hydric Soils3:
Dark Surface (S7) ❑ 2 cm Muck (A10) (MLRA 147)
Polyvalue Below Surface (S8) (MLRA 147, 748) ❑ Coatal Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 748) (MLRA 147, 748)
Loamy Gleyed Matrix (F2) ❑ Piedmont Floodplain Soils (F19)
Depleted Matrix (F3) (MLRA 136, 747)
Redox Dark Surface (F6) ❑ Very Shallow Dark Surface (TF12)
Depleted Dark Surface (F7) ❑ Other (Explain in Remarks)
Redox Depressions (FS)
Iron-Manganese Masses (F12) (LRR N, MLRA 136)
Umbric Surface (F13) (MLRA 136, 722)
Piedmont Floodplain Soils (F19) (MLRA 148)
Red Parent Material (F21) (MLRA 127, 747)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes ❑ No �
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

� WETLANDi RAT`IN�G VG'(?R1�SHEET Fourth Version I
Project Na.m�� `.�-3 s5�--- ,�/l/ PJ�/�tG� �� Nearest Road � �`��''�",� �`' � �
Cot�nty IC OG Lr 1�� h� c�+ Wetland axea G'� O�acres Wetland width 2 D feet
v t � 2 �/�
I'�ame of evaltaatar f«u.�' S� � cr1'��r, ��' -` Date l���r u�� �f ;,
Wetland lacation
on pond 4r lake
� on perez�z�ia➢ stream
on intermittent stream
� within interstream divide
Ot�"i�l':
�f7apru s ,%�� D —�°o sl,l�j
'�OII SCR'1�5: �C,�-�-+.r�n��r�. .��no,/cr� i
� predominantly orbanic humus, muck, oz'
peat
� predorninantly rnineral - non-sandy
_ predorninantly sandy
Hydrauiic factors
s�eep to�ography
ditched or channelized
total «Tetland widt�a > 140 feet
Wetland Eype (select one}�
� Bottomland hard�,vood farest
_ Headwatez forest
_ Swamp forest
� Wet flat
Pacasin
� Bog forest
Ad,�acent laud nse
�wrthin.'/z mile upstream, upslope, ar radius)
farestedlnatural vegetation �O %
X agriculture, urban/s�burban �� %
� i ervi us surface \ /Q %
�t-t7r� 1'anclr...�t.c�J
Dominant vegetati4n
( i ) � as rzt.ff�� .S'^ec� ��
(�}
(3)
Flooding and wetness
semiperman�ntly to germanently flQoded oc
��tundated
seasonally flooded ar inund�ted
I intermittently flooded ar #emporary suc•face water
no evidence of floading or surface water
_ Pine savanna
Freshwater marsh
� Bog/fen
� Ephemeral wetl�d
Caralina bay
� Other:
` The ratina system cannot be applied to salt or brackish marshes or stream cha�anels
:- �-------------W ater storage � _,.� ` �r x 4.Oa = �
� Wetland
� A BanklShoreline stabilization �. x 4.fl0 =� ratin�
� T Po�luTant removal _ � "' x �.{�p = 5� � �
; I Wildlife habitat � x 2.00 =�1 �
� ��
; N Aquatic life value 2- x 4.Ofl =�
; G Recreation/Education � - x 1.00 � �
'�* Ac#d 1 point if in sens9tive watershecl a3td>10% nanpoint source disturbance within '/z i�ile upstream, upsiope, or radius

� 1vVETLAND RATI�G '�'VORKSHEET Foarth Versian I
Project Na�� ����.J C��'�/l ��"° ���'�� Nearest Road -���l��i /C oar.�
County � o�t�/'i�, �� v� ��Jetland area �.� acres VVetla�lc€ width 5�a ,�D feet
N�me of evatuatar J av� e��t-1 �l��' 1✓', 1 G✓S D�te i`�v�r� «�^ y��D/�
�Vetland locatir�n
an p�nd or lake
___ ��.1 per�nnial strea�li
_ on intea•initt�:nt stream
witllin interstrea��� divid�
� other: ,�i'2 r'� a ce.prc� yAs� �aJefl�i�,.ra�
f� 4�- a a�'
Soil ser[es: ��°ru�'�v�'",. p-� l Sr'��.5
-� -ua�# , a��a — f
� predominau�arga�-�st�rr�us, mv�k, or
peat
� preclomina��tly rrYineral - F�on-sandy
__ predominantl5� sandy�
Hvdraulic factc�rs
_� steep topo�raphy
ciitched or channelizec�
TT�� total ��etla��d �vidth > 100 feet
Adjacent la�d Yyse
(��ithin '/� mile u�streat�l, upslQpe, ar r�dius)
�C �c�rested/natural vegetation �'Q_°fo
�a�ricuiture, ��rba��/s�burban /� '!o
imp tvious surface fC7 %
� ¢ ur� ro�lr,�`x�)
Dominant vegetation �% �
� � ) � � 12c,S'r'�i � r" ,��t�Yf/C�f?'�...i��S
��) __.__--- -
��)
Floading and wetness
se�llipermanently to permdnently tlooded or
inu��dated
seasonally flooded c�r inunciateci
� intermittentky f�ac�c3ed �r tetnporary sui-face water
no evidence a� flaoding o�� surface w�ater
V4'etland type (select one)�
Bottomland hardwc�od forest �'ine savann�
Head���ater forest � Fr�sh«•�ter marsh
_ Sw�inp forest � Bu�/fen
_ Wet f[at � Epl�emeral ���etlanci
Pocosin C;aroiina bav
_ Bog forest �Otl� r: L,/�'�/�.� DCcur�'rh B��a y',v�r.�r�r�a
6� �s ��� ,� ` ,-�d �Q `�
A� ,.�Ji rs7��''►- ✓ �i s�►%�� f�i'�i�
' Tlie �atmg svsie�t� cannot be applie� tc� salf ar brack3sh ma� �hes �r st�e�m channels Q� Q�����
------ - -�----..��. . . -
�� ____
..�_... .e._._ . ---- —__.__ _..�.__ _.__ _ __ . ._. __ _� ,- --- - - ---- --- .
.--- _.... � . 1
; R Watei 5torage x 4.OE} _�
; A Ban1c1S1iQreline stabilization (� x��� -� Wetland
' T �ollutan� remo��al r�iinr; ,
�—;g x �r.00 = 3' �
; I W�ldlife hahslat � X 2.pQ =� � �
G �� � '
; N A�uatic ]ife wal�a� __��_,_ x 4.00 =� � I �;
F ;
; G Rec�eatian/Education � x I.00 = � _
� F
��" Ac��l l�oint i[� it� sensitive ��-atershed and>If}4!u nan�oint sc�urcc i�isturbane� �A itliin :/z si�iie upstrea�i�, u�sioE�e, �� raclii�s