20160026 Ver 1_401 Application_20151215

(3 Stantec
December 21, 2015
File: 175613068
Attention: Cherri Smith
NC DWR
401 & Buffer Permitting Unit
512 North Salisbury Street
Raleigh, NC 27604
Dear Ms. Smith,
11 ID��goI
DEC 2 9 2015
Reference: Fernbrook Lift Station Abandonment and Gravity Sewer 404 Permitting
The Winston Salem City/Forsyth County Utilities is requesting a review and permitting approval for
the Fernbrook Lift Station Abandonment and Gravity Sewer Extension. Please find the
preconstruction notification attached, along with the permitting submittal package. A submittal
package has also been sent to the Raleigh Regulatory Field Office of the US Army Corps of
Engineers for 404 permitting.
If you have any questions regarding the permit review, please contact me.
Regards,
Stantec Consulting Inc.
Yana Stewart, PE
Senior Project Engineer
Phone: [phone]
[e-mail]
Attachment: PCN, Permit Package, Check
c. Bill Ward, City/County Utilities
John T. Thomas, Army Corps of Engineers
js c:\users\janstewart\documents\projects\winstonsolem\fembrook\permitting\pcn\raleighdwr_coverlette20151221.docx
Design with community in mind

December 21, 2015
File: 175613068
Attention: John T. Thomas
Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
Dear Mr. Thomas,
Reference: Fernbrook Lift Station Abandonment and Gravity Sewer 404 Permitting
The Winston Salem City/Forsyth County Utilities is requesting a review and permitting approval for
the Fernbrook Lift Station Abandonment and Gravity Sewer Extension. Please find the
preconstruction notification attached, along with the permitting submittal package. A submittal
package has also been sent to the NC DWR for a 401 permit.
If you have any questions regarding the permit review, please contact me.
Regards,
Stantec Consulting Inc.
Jana Stewart, PE
Senior Project Engineer
Phone: [phone]
[e-mail]
Attachment: PCN, Permit Package
c. Bill Ward, City/County Utilities
Cherri Smith, NC DWR
js c:\users\janstewart\documents\projects\winstonsalem\fernbrook\permitting\pcn\raleighocoe_coverlette20151221.docx
Design with community in mind

December 21, 2015
File: 175613068
Attention: Sue Homewood
NC DWR
401 & Buffer Permitting Unit
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Dear Ms. Homewood,
Reference: Fernbrook Lift Station Abandonment and Gravity Sewer 404 Permitting
The Winston Salem City/Forsyth County Utilities is requesting a review and permitting approval for
the Fernbrook Lift Station Abandonment and Gravity Sewer Extension. Please find the
preconstruction notification attached, along with the permitting submittal package. A submittal
package has also been sent to the Raleigh Regulatory Field Office of the US Army Corps of
Engineers for 404 permitting. The 401 permit package and fee check were sent to Cherri Smith in
the Raleigh DWR for processing. A copy of the permit is included within because of the minimum
nature of the impacts with the possibility of permitting within the local office.
If you have any questions regarding the permit review, please contact me.
Regards,
Stantec Consulting Inc.
na Stewart, PE
Senior Project Engineer
Phone: [phone]
[e-mail]
Attachment: PCN, Permit Package, Check
c. Bill Ward, City/County Utilities
Cherri Smith, NC DWR
is c:\users\janstewart\documents\projects\winstonsolem\fembrook\permitting\pcn\winstondwr_coverletter20151221.docx
Design with community in mind

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre -Construction Notification (PCN) Form r 6 6
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X No
1d.
Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ❑X No
For the record only for Corps Permit:
❑ Yes ❑X No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
❑ Yes ❑X No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑ Yes ❑X No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a.
Name of project:
Fernbrook Lift Station Abandonment and Gravity Sewer Outfall
2b.
County:
Forsyth
2c.
Nearest municipality / town:
Winston-Salem
2d.
Subdivision name:
Bridgton Place
2e.
NCDOT only, T.I.P. or state project no:
n/a
3.
Owner Information
3a. Name(s) on Recorded Deed:
City of Winston-Salem
3b.
Deed Book and Page No.
various
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
101 N. Main Street
3e.
City, state, zip:
Winston-Salem, NC 27102
3f.
Telephone no.:
336-727-8000 or 336-747-7306
3g.
Fax no.:
na
3h. Email address:
[e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
Jana Stewart
5b. Business name
(if applicable):
Stantec Consulting Services, Inc.
5c. Street address:
301 North Main Street, Suite 2452
5d. City, state, zip:
Winston -Salem, NC, 27101-3844
5e. Telephone no.:
336-392-4051
5f. Fax no.:
5g. Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID):
various
1 b. Site coordinates (in decimal degrees):
ILatitude: 36.027712 Longitude: -80.250489
1 c. Property size:
1.284 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
UT to Perryman Branch
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
Yadkin -Pee Dee
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 vegetation mostly consists of disturbed/early successional forest that has been timbered in the past. There are some small sections of the project
area that include maintained residential landscaped yards. The watershed mainly consists of residential development. Stormwater is a primary input to
the waters within and adjacent to the property.
3b. List the total estimated acreage of all existing wetlands on the property: 0.13
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 80
3d. Explain the purpose of the proposed project:
A lift station will be abandoned and replaced with gravity sewer reducing maintenance and chances of lift station failures.
3e. Describe the overall project in detail, including the type of equipment to be used:
Lift station will be removed and backfilled. Trench excavation equipment will be utilized for new 8 inch sanitary sewer installation and manholes.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall rior phases)in the past?
❑ Yes ❑X No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
E]Prelimina Preliminary Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Preliminary JD is requested as part of this permit application.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑Yes 0 No ElUnknown
5b. If yes, explain in detail according to "help file" instructions.
N/A
6. Future Project Plans
6a. Is this a phased project?
❑ Yes Q No
6b. If yes, explain.
N/A
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑X Wetlands ❑X 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 of impact
Type of wetland
Forested
Type of jurisdiction
Area of
number
Corps (404,10) or
impact
Permanent (P) or
DWQ (401, other)
(acres)
Temporary T
W1 T
Land Clearing
Headwater Wetland
Yes
Corps
0.04
W2 P
Land Clearing
Headwater Wetland
Yes
Corps
0.09
W3
Choose one
Choose one
Yes/No
-
W4
Choose one
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
W6
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
0.13
2h. Comments:
The area where the new gravity sewer line will be placed is listed as a permanent impact (0.09 ac) as a result of converting the forested wetland to a
maintained access corridor. The temporary impact (0.04 ac) listed is associated with a temporary construction easement where trees will be cut but
replanted.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial (PER) or
Type of
Average
Impact
number
intermittent (INT)?
jurisdiction
stream
length
Permanent (P) or
width
(linear
Temporary (T)
(feet)
feet)
S1 T
Stabilization
UT to Perryman Branch
INT
Corps
8
22
S2 T
Excavation
UT to Perryman Branch
INT
Corps
4
58
S3
Choose one
S4
Choose one
S5
Choose one
S6
Choose one
3h. Total stream and tributary impacts
80
3i. Comments:
The temporary stabilization impact involves replacing existing riprap around the culvert that flows under Fernbrook Dr. The temporary excavation
impact involves the removal of an 8 -in aerial sanitary sewer line and installation of a new 4 -in service line to a residence. The 8 -in sewer line crosses
the stream at a 45 degree angle, and the 4 -in service line will cross the stream perpendicularly. This new 4 -in service line is necessary to provide
access to the residence which is being lost by the removal of the 8 -in sewer line.
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01
Choose one
Choose
02
Choose one
Choose
03 -
Choose one
Choose
04
Choose one
Choose
4f. Total open water impacts
4g. Comments: n a
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
(acres)
Flooded
Filled
Excavated Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments: n/a
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):.
5j. 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. Project is in which protected basin?
❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other:none
6b.
Buffer Impact
number —
Permanent (P) or
Temporary T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
131
Yes/No
B2 -
Yes/No
63 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
6i. Comments: n/a
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The wetland impacts have been minimized by proposing the permanent easement to run along the toe of slope and completely avoid the stream
adjacent to the wetland in this area. The stream impacts on the northern end of the project are all temporary in nature, a 4 -inch aerial service line is
being installed perpendicular to the stream to replace an 8 -in sewer line that crosses the stream at a 45 degree angle. The new 4 -inch is to provide
service to a house. The riprap is only being replaced along the leftbank as the riprap on the rightbank is still providing adequate stabilization.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Typical sediment and erosion control measures will be taken on site. Tree protection fencing will be used to protect jurisdictional waters that will not be
impacted. Appropriately sized equipment will be utilized to prevent excessive compacting and minimize clearing. Construction scheduling and staging
will be timed to minimize the amount of time spent working in the stream channel. An Erosion and Sediment Control Plan will be submitted to the NC
Department of Energy, Mineral, and Land Resources for approval prior to construction.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes X❑ No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
El Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: N/A
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
0 linear feet
4c. If using stream mitigation, stream temperature:
Choose one
4d. Buffer mitigation requested (DWQ only):
0 square feet
4e. Riparian wetland mitigation requested:
0 acres
4f. Non -riparian wetland mitigation requested:
0 acres
4g. Coastal (tidal) wetland mitigation requested:
0 acres
4h. Comments: N/A
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.
N/A
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
X
El 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
N/A
3 (2 for Catawba)
Zone 2
N/A
1.5
6f. Total buffer mitigation required:
o
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).
N/A
N/A
6h. Comments:
Page 7 of 10

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 ❑X No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
0
2b. Does this project require a Stormwater Management Plan?
❑ Yes ❑x No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
Impervious area is not being added as part of this project.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
n/a
3. Certified Local Government Stormwater Review
3a. In which localgovernment's jurisdiction is thisproject?
City of Winston-Salem
❑ Phase II
❑ NSW
3b. Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4. DWQ Stormwater Program 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
❑ Yes ❑ No
attached?
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
Page 8of10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑x Yes ❑ No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ❑X 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 ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
❑Yes ❑X No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project, (based on past and reasonably anticipated future impacts) result in
El Yes ❑X No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
This is an improvement of an existing sewer pipe to allow the system to operate more efficiently.
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.
n/a
Page 9 of 10
PCN Form — Version 1.4 January 2009

P5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat?
El Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act
0Yes [J No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
E
-
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The NC Natural Heritage Data Explorer did not identify any element occurrences within a 1 -mile radius of the project site. The USFWS identified 4
Federal Status species. Of the 4 species identified, the Northern Long-eared Bat has habitat within the project site. Additional information is attached.
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?
1998 Final Habitat Plan for the South Atlantic Region: Essential Fish Habitat Requirements for Fishery
South Atlantic Fishery Management Council Habitat and Ecosystem Atlas (http://ocean.flohdamarine.org/safmc_atlas!)
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ❑ No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
The NCSHPO GIS web service shows no historic or archaeological resources within a mile of the subject site. http://gis.ncdcr.gov/hpoweb
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
N/A
8c. What source(s) dies you use to make the floodplain determination?
NC Floodplain Mapping 1 FIRMA
Appf anUAgent's Signature
I ApplicanUAgent's Printed Name
Date
(Agent's sigr�Va re is valid only if an authorization
letterirom the applicant isprovided.)
Page 10 of 10

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Pas PCD2 Determination Request
Fern v
brook Gravity
Outfall
= PcD2
Pas PcC2 Forsyth County, NC
EL
PcC2
Title:
PeE3 -�
J' Pa PeE3
CcB
` PaC NRCS SOIL SERIES
_ MAP
Wes PcD2
Ref. NRCS Soil Series Data
WeC G Forsyth, SC (1976)
Mapped Soil Units Within the PSA
— r WdD
LwE - Louisburg -Wedowee complex
15-25%
_ A C W k B PaC Pacolet f r sandy loam 5-10%
` PcD2 Pacolet clay loam 10-15%
eroded
PeE3 Pacolet complex 10-25%
7
ee� severely eroded
G` WeC Wedowee Louisburg complex
ApB `, &10%
Wh Wehadk [HYDRIC)
V' a�
F A113 o�
a
F
Drawn By: DA/QC Review.
t
AEB MR
x.
Peer Revlew: Date:
w
.` ALC 5/20/2015
Stantec Project/Task Number:
cB 175613066/200
0 375 750 1,500M09 FIGURE 3
- �. Feet

Legeillu
Project Study Area
Hydrography
(3 Stantec
,.
Client:
-
� V
It f
CITY OF
(Q
WIN510 OWS N -SALEM
Project:
'
Jurisdictional
PUBHh
*' ,
�f
Determination Request
Fernbrook Gravity
Outfall
Forsyth County, NC
s t�
NATIONAL WETLAND
INVENTORY MAP
Ref. FWS CONUS Wetland Data
Forsyth, NC (1994)
No NWI Polygons
are Mapped
within PSA
ct.. `�:. e Drawn By: QA/QC Review:
AEB MR
PUBHh Peer Review: Date:
ALC 5/20/2015
Stantec Projeci/Task Number:
175613066/200
y:
0 375 750 1,500 FIGURE 4
Feet

`. Culvert, Stream A-3 DP
Wetland A; 0.294 ac ---�. ,
Lat: 36.024832 N "' Stant@c
Long: 80.252269 W 1 '
. 1 a
Stream A (Centerline);
230 If Client:
Stream A-1 DP Lat: 36.030983 N - ��
Long: 80.248823 W
1 1 „y, WIN T N- ALEM
Project:
>Wxks s .
1 1 .. _ . i✓ t .. ..yy ;
Jurisdictional
Determination Request
t l _ • °e
Fernbrook Gravity
" Outfall
y
Al
Stream A-2 DP
Forsyth Count NC
Y y.
Upland A DP
Wetland A DP
Title:
APPROXIMATE WATERS
�r1c OF THE U.S. AND
WETLANDS LOCATION
MAP
Ref.
National Agriculture Imagery
Program (NAIP) Aerial Photography
-,.'� Forsyth County, NC (2013)
Stream A (Left Top of Bank);
_ .. 85 If
..
Forsyth County
Lat: 36.025971 N
Long: 80.251268 W
:77
Inlet
Inlet PI Dr i
Drawn By: QA/QC Review:
Legend
n AEB MR
Project Study Area (4.679 ac) Peer Review: Date: i _
.� ALC 5/20/2015
Jurisdictional Stream - Delienated (315 If) a s'an'e° Project Number
i Rri tui ape t m` 175613066/200
Jurisdictional Stream - Not Delienated
Notes:
Jurisdictional boundaries of the waters of the U.S. have 0 ) 25 250 500 FIGURE 5
Jurisdictional Wetland (0.294 ac) not been verified by the U.S. Army corps of Engineers Feet
I
and are subject to change following verification.

Forsyth Courbty Endangered Species, Threatened Species,Federal Species of Concern, and Candidate Species
Endangered Species, Threatened Species,Federal Species of Concern, and
Candidate Species,
Forsyth County, North Carolina
Updated: 7-24-2015
Common Name
Scientific name
Federal
Record Status
Status
Vertebrate:
Bog turtle
Glyptemys muhlenbergii
T (S/A)
Current
Northern long-eared bat
Myotis septentrionalis
T
Probable/Potential
Invertebrate:
Brook floater
Alasmidonta varicosa
FSC
Current
Vascular Plant:
Small-anthered bittercress
Cardamine micranthera
E
Historic
Nonvascular Plant:
Lichen:
Definitions of Federal Status Codes:
E = endangered. A taxon "in danger of extinction throughout all or a significant portion of its range."
T = threatened. A taxon "likely to become endangered within the foreseeable future throughout all or a significant
portion of its range."
C = candidate. A taxon under consideration for official listing for which there is sufficient information to support listing.
(Formerly "Cl" candidate species.)
BGPA =Bald and Golden Eagle Protection Act. See below.
FSC=Federal Species of Concern. FSC is an informal term. It is not defined in the federal Endangered Species Act. In
North Carolina, the Asheville and Raleigh Field Offices of the US Fish and Wildlife Service (Service) define Federal
Species of Concern as those species that appear to be in decline or otherwise in need of conservation and are under
consideration for listing or for which there is insufficient information to support listing at this time. Subsumed under the
term "FSC' are all species petitioned by outside parties and other selected focal species identified in Service strategic
plans, State Wildlife Action Plans, or Natural Heritage Program Lists.
T(S/A) = threatened due to similarity of appearance. A taxon that is threatened due to similarity of appearance with
another listed species and is listed for its protection. Taxa listed as T(S/A) are not biologically endangered or threatened
and are not subject to Section 7 consultation. See below.
EXP = experimental population. A taxon listed as experimental (either essential or nonessential). Experimental,
nonessential populations of endangered species (e.g., red wolf) are treated as threatened species on public land, for
consultation purposes, and as species proposed for listing on private land.
http://www.fws.gov/raleigh/species/cntylist/forsydi.html[12/10/2015 10:23:57 AM]

F6rsyth County Endangered Species, Threatened Species,Federal Species of Concern, and Candidate Species
P = proposed. Taxa proposed for official listing as endangered or threatened will be noted as "PE" or "PT", respectively.
Bald and Golden Eagle Protection Act (BGPA):
In the July 9, 2007 Federal Register( 72:37346-37372), the bald eagle was declared recovered, and removed (de -listed)
from the Federal List of Threatened and Endangered wildlife. This delisting took -effect August 8,2007. After delisting,
the Bald and Golden Eagle Protection Act (Eagle Act) (16 U.S.C. 668-668d) becomes the primary law protecting bald
eagles. The Eagle Act prohibits take of bald and golden eagles and provides a statutory definition of "take" that
includes "disturb". The USFWS has developed National Bald Eagle Management Guidelines to provide guidance to
land managers, landowners, and others as to how to avoid disturbing bald eagles. For mor information, visit
httD://www.fws.Lyov/miizratorvbirds/baldeaLyle.htm
Threatened due to similarity of appearance(T(S/A)):
In the November 4, 1997 Federal Register (55822-55825), the northern population of the bog turtle (from New York
south to Maryland) was listed as T (threatened), and the southern population (from Virginia south to Georgia) was
listed as T(S/A) (threatened due to similarity of appearance). The T(S/A) designation bans the collection and interstate
and international commercial trade of bog turtles from the southern population. The T(S/A) designation has no effect on
land management activities by private landowners in North Carolina, part of the southern population of the species. In
addition to its official status as T(S/A), the U.S. Fish and Wildlife Service considers the southernpopulation of the bog
turtle as a Federal species of concern due to habitat loss.
Definitions of Record Status:
Current - the species has been observed in the county within the last 50 years.
Historic - the species was last observed in the county more than 50 years ago.
Obscure - the date and/or location of observation is uncertain.
Incidental/migrant - the species was observed outside of its normal range or habitat.
Probable/potential - the species is considered likely to occur in this county based on the proximity of known records (in
adjacent counties), the presence of potentially suitable habitat, or both.
http://www.fws.gov/raleigh/species/cntylist/forsyth.html[12/10/2015 10:23:57 AM]

NORTH CAROLINA DEPARTMENT OF NATURAL AND CULTURAL RESOURCES
Pat McCrory Bryan Gossage Susan Kluttz
Governor Executive Director Secretary
Clean Water Management Trust Fund
NCNHDE-1044
December 10, 2015
Alexander Baldwin
Stantec_Consulting_Services Inc.
801 Jones Franklin Road
Raleigh, NC 27606
[e-mail]
RE: Fernbrook Gravity Outfall - Revised; 175613066
Dear Alexander Baldwin:
The North Carolina Natural Heritage Program (NCNHP) appreciates the opportunity to provide information
about natural heritage resources from our database that have been compiled for the project referenced
above.
A query of the NCNHP database, based on the project area mapped with your request, indicates that there
are no records for rare species, important natural communities, natural areas, or conservation/managed
areas within the proposed project boundary, or within a one -mile radius of the project boundary.
Please note that the results of this query should not be substituted for site-specific surveys where suitable
habitat exists. Although there may be no documentation of natural heritage elements within the project
boundary, it does not imply or confirm their absence; the area may not have been surveyed. In the event
that rare species are found within the project area, please contact the NCNHP so that we may update our
records.
Please also note that natural heritage element data are maintained for the purposes of conservation
planning, project review, and scientific research, and are not intended for use as the primary criteria for
regulatory decisions. Information provided by the NCNHP database•may not be published without prior
written notification to the NCNHP, and the NCNHP must be credited as an information source in these
publications. Maps of NCNHP data may also not be redistributed without permission.
Thank you for your inquiry. If you have questions regarding the information provided in this letter or need
additional assistance, please contact John Finnegan at iohn.finnegan ncdenr.gov or 919.707.8630.
Sincerely,
NC Natural Heritage Program
Page 1 of 2

NCNHDE-1044: Fernbrook Gravity Outfall - Revised
i y i
December 10, 2015
❑ Project Boundary
❑ Buffered Project Boundary
Page 2 of 2
1:24,976
0 0.2 OA 0.8 mi
0 0.325 0.65 1.3 km
SourcesEvi, HERE, DeLonne, Intermap, in mens P Corp., GEBCO,.
USGS, FAO, NPS, NRCAN, GaoBasa. IGN, Kadaster NL. Ordnance Survey,

Estimated
amount of
Class of
Site Number
Latitude
Longitude
Cowardin Class
aquatic
aquatic
resourcein
resource
review area
Stream A-3
36.030983 N
80.248823 W
R4SB
230 -If
Non -section 10
— non -wetland
Stream A
36.025971 N
80.251268 W
R3SB
85 -If
Non -section 10
— non -wetland
Wetland A
36.024832 N
80.252269 W
PFO
0.294 -ac
Non -section 10
— wetland

USACE AID# DWQ # Site # SA -I (indicate on attached map)
MSTREAM QUALITY ASSESSMENT WORKSHEET
4dW
Provide the following information for the stream reach under assessment:
1. Applicant's name: City of Winston-Salem 2. Evaluator's name: A. Baldwin
3. Date of evaluation: 5/22/2015 4. Time of evaluation: 11:07
5. Name of stream: UT to Perryman Branch 6. River basin: Yadkin
7. Approximate drainage area: 144 ac 8. Stream order: Second
9. Length of reach evaluated: 200 ft 10. County: Forsyth
11 Site coordinates (if known): Prefer in decimal degrees. 12. Subdivision name (if any): n/a
Latitude (ex. 34.872312): 36.025096 Longitude (ex. - 77.556611): -80.252181
Method location determined (circle): IGPTopo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
See man.
14. Proposed channel work (if any):
15. Recent weather conditions: 0.5" rainfall the day before (5/21), last measurable rain event prior was on 5/11.
16. Site conditions at time of visit: Sunny - mid 70's
17. Identify any special waterway classification known: _ Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters Nutrient Sensitive Waters _Water Supply Watershed
(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES ® If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? © NO 20. Does channel appear on USDA Soil Survey? 0
NO
21. Estimated watershed land use: 60% Residential % Commercial % Industrial
% Agricultural
25% Forested 15% Cleared / Logged _% Other (
1
22. Bankfull width: 4 ft 23. Bank height (from bed to top of bank): 1 ft
24. Channel slope down center of stream: X % Flat (Oto 2%) _% Gentle (2 to 4%) _% Moderate (4 to 10%) _% Steep (>10%)
25. Channel sinuosity: _Straight X Occasional bends Frequent meander % Very sinuous _Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on location, terrain,
vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points to each characteristic within the
range shown for the ecoregion. Page 3 provides a brief description of how to review the characteristics identified in the worksheet. Scores should
reflect an overall assessment of the stream reach under evaluation. If a characteristic cannot be evaluated due to site or weather conditions enter 0 in
the scoring box and provide an explanation in the comments section. Where there are obvious changes in the character of a stream under review
(e.g., the stream flows from a pasture into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form
used to evaluated each reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of
the highest quality.
Total Score (from reverse): 67
bank outside of the PSA.
Comments: Evaluated downstream of confluence with small tributary along right
Evaluator's Signature: 0.5,4-1-
5 // Date: 5/22/2015
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in gathering the
data required by the United States Army Corps of Engineers to make a preliminary assessment of stream quality. The total score resulting
from the completion of this form is subject to USACE approval and does not imply a particular mitigation ration or requirement. Form
subject to change - version 06/03. To Comment, please call 919-8776-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION
POINT RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0-4
0-5
4
(no flow or saturation --O; strong flow--maxpoints)
2
Evidence of past human alteration
0-6
0-5
0-5
4
(extensive alteration --0; no alteration=maxpoints)
3
Riparian zone
0-6
0-4
0-5
4
no buffer=0; contiguous, wide buffer maxpoints)
4
Evidence of nutrient or chemical dischargers
0-5
0-4
0-4
2
(extensive discharges=0; no dischar es=max points)
5
Groundwater discharge
(no discharge=0; springs, seeps, wetlands, etc.=maxpoints)
0-3
0-4
0-4
4
6
Presence of adjacent floodplain
0-4
0-4
0-2
3
y,
(no flood lain=0; extensive flood lain=maxpoints)
a7
Entrenchment / floodplain access
0-5
0-4
0-2
4
(deeply entrenched=0; frequent flooding--maxpoints)
8
Presence of adjacent wetlands
0-6
0-4
0-2
3
(no wetlands=0; large adjacent wetlands=max points
9
Channel sinuosity
0-5
0-4
0-3
3
(extensive channelization=0; natural meander--maxpoints)
10
Sediment input
0-5
0-4
0-4
1
(extensive deposition=0; little or no sediment--maxpoints)
11
Size & diversity of channel bed substrate
NA*
0-4
0-5
1
(fine, homo eneous=0; large, diverse sizes=maxpoints)
12
Evidence of channel incision or widening
0-5
0-4
0-5
3
(deeply incised=0; stable bed & banks=max oints)
y
F+
13
Presence major bank failures
of
0-5
0-5
0-5
4
M(severe
erosion=0; no erosion, sable banks=maxpoints)
Q
14
Root depth and density on banks
0-3
0-4
0-5
4
E-+
(no visible roots=0; dense roots throughout --max points)
`n
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
4
(substantial impact --O; no evidence=max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
3
(no riffles/ripples or ools=0; well-developed=max points)
Q
17
Habitat complexity
0-6
0-6
0-6
3
E
(little or no habitat --O; frequent, varied habitats=maxpoints)
18
Canopy coverage over streambed
0-5
0-5
0-5
4
(no shading vegetation --O; continuous canop — ax points)
19
Substrate embeddedness
NA*
0-4
0-4
0
(deeply embedded=0; loose structure=maxpoints)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
2
(no evidence --O; common, numerous types=tnaxpoints)
21
Presence of amphibians
0-4
0-4
0-4
2
p
(no evidence=0; common, numerous types=maxpoints)
O
22
Presence of fish
0-4
0-4
0-4
0
pq(no
evidence 0; common, numerous types=maxpoints)
23
Evidence of wildlife use
0-6
0-5
0-5
5
(no evidence=0; abundant evidence=maxpoints)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
67
* These characteristics are not assessed in coastal streams.

NC DWO Stream Identification Form Version 4.11
Date: 5/22/2015
Project/Site: Fernbrook
Latitude: 36.025096
Evaluator: A. Baldwin & N. Ronan
County: Forsyth
Longitude: -80.252181
Total Points: 39
Stream Determination (circle one)
OtherStream A - 1
Stream is at least intermittent
Ephemeral Intermittent Perennial
P
e. Quad Name:
g. Winston -Sale
if >_ 19 or perennial if> 30'
2
3
East and West
A. Geomorphology (Subtotal= 19.5 )
Absent
Weak
Moderate
Strong
,a, Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
1
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
2
3
4. Particle size of stream substrate
0
1
2
3
5. Active/relict floodplain
0
1
2
3
6. Depositional bars or benches
0
1
2
3
7. Recent alluvial deposits
0
1
2
3
8. Headcuts
0
1
2
3
9. Grade control
0
0.5
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
No = 0
Yes = 3
a artificial ditches are not rated; see discussions in manual
B. Hvdroloqv (Subtotal = 12.5 )
12. Presence of Baseflow
0
1
2
3
13. Iron oxidizing bacteria
0
1
2
3
14. Leaf litter
1.5
1
0.5
0
15. Sediment on plants or debris
0
0.5
1
1.5
16. Organic debris lines or piles
0
0.5
1
1.5
17. Soil -based evidence of high water table?
0
No = 0
Yes = 3
1.5
C. Bioloav (Subtotal = 7
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos (note diversity and abundance)
0
1
2
3
21. Aquatic Mollusks
0
1
2
3
22. Fish
0
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians
0
0.5
1
1.5
25. Algae
0
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5 Other = 0
'perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Data point taken downstream of confluence
with small trib
entering on LB. Stormwater culverts from
subdivision enter along LB. Riparian buffer is - 150' along
LB and
> 150' along RB.
Sketch:

USACE AID#
DWQ#
Site # SA -2
Q STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name: City of Winston-Salem
3. Date of evaluation: 5/22/2015
5. Name of stream: UT to Perryman Branch
7. Approximate drainage area: 114 ac
9. Length of reach evaluated: 200 ft
2. Evaluator's name: A. Baldwin
4. Time of evaluation: 13:09
6. River basin: Yadkin
8. Stream order: Second
10. County:
(indicate on attached map)
11 Site coordinates (if known): Prefer in decimal degrees. 12. Subdivision name (if any): n/a
Latitude (ex. 34.872312): 36.028341 Longitude (ex. - 77.556611): -80.250814
Method location determined (circle): ® Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location): See man.
14. Proposed channel work (if any):
15. Recent weather conditions: 0.5" rainfall the day before (5/21), last measurable rain event prior was on 5/11.
16. Site conditions at time of visit: Sunnv- Mid 70's
17. Identify any special waterway classification known: _ Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters Nutrient Sensitive Waters _Water Supply Watershed (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES ® If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ©S NO 20. Does channel appear on USDA Soil Survey? 0 NO
21. Estimated watershed land use: 70% Residential % Commercial % Industrial _% Agricultural
30% Forested _% Cleared / Logged _% Other ( 1
22. Bankfull width: 4 ft 23. Bank height (from bed to top of bank): 1.5 ft
24. Channel slope down center of stream: X % Flat (Oto 2%) o/o Gentle (2 to 4%) % Moderate (4 to 10%) _% Steep (>10%
25. Channel sinuosity: _Straight X Occasional bends Frequent meander _% Very sinuous _Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on location, terrain,
vegetation, stream classification, etc. Every characteristic must lye scored using the same ecoregion. Assign points to each characteristic within the
range shown for the ecoregion. Page 3 provides a brief description of how to review the characteristics identified in the worksheet. Scores should
reflect an overall assessment of the stream reach under evaluation. If a characteristic cannot be evaluated due to site or weather conditions enter 0 in
the scoring box and provide an explanation in the comments section. Where there are obvious changes in the character of a stream under review
(e.g., the stream flows from a pasture into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form
used to evaluated each reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of
the highest quality.
Total Score (from reverse): 72
Comments:
Evaluator's Signature: // M_ Date: 5/22/2015
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in gathering the
data required by the United States Army Corps of Engineers to make a preliminary assessment of stream quality. The total score resulting
from the completion of this form is subject to USACE approval and does not imply a particular mitigation ration or requirement. Form
subject to change - version 06/03. To Comment, please call 919-8776-8441 x 26.
1

STREAM QUALITY ASSESSMENT WORKSHEET
# . CHARACTERISE ICS
:.
* These characteristics are not assessed in coastal streams. ,
µ
EC' OREGION
POM_,AANGE
SCORE
,C diifaf.
; . Piedmont , • ,Mountain -
1, .
;Presence of flow /persistent pools in stream"
0;= 5'
6=4
0— 5
4
(rip flow�or satdration=0; strong flo-A-max oiii")
' Evde`iice of"past Human -alteration '.'
0 = 6
0,= 5
0-5
3
extensive alte"ration=0 no alteration -max ' oiiits
(1
Riparian zone
0— 6
0_ 4
0— 5
4
no: buffer=0; contiguous, wide bud'e` i ax p6ints
4'
Evidence of nutrient or chemical ;dischargers '.
0- 5
0-4
0 - 4
3
(extensive discharges=0;. no . 1 char es=max points)
5.'
= Groundwater discharge
a
d
''dischar a -0'"s rin s see s wetlands etc.=max oints)
nog- ; g; ,
0-3
0 —.4
D-4
3
6, `
"`- -..:;i^" Presence of adjacentfloodplain
0-4
0 = 4'
0-2
4
no flood` lain=0;' extensive flood lain=niax oints
a7
"
_ Eiitrencbnient) floodplain::access.
:;:�
_,... ;- -
`(dee ' ly eritrenclied=0; fre uent flooding -max Points)
0-5
0-4
0�=2
2
8:
; f ` " 'Presence of adjacent wetlands
0 = 6
0 = 4 "
O-2
1
(no:wetlands; 0; large,adjacent'wetlah&=m`ax points ., ,
. , Channel siniiosi
f
,
(extensive: cliarinelizatioii=0; natural:irieandei=max pints) ,
10
-<` 5edimenfinpiif;'
`osition-0.little '
;(extensive de of ;no sedim`erit=max oi_rits).
11'
:Size 4"I.i.. ... channefbed':sutistr`ate•:
liorno "eneous=0 ,lar` a ''diveise,sizes=iiiax
:`Evidence:of`chatinel fncision`or=wideuini'° •`
_-:'(deeplyincisedn0 'stable`bed'"8i`;banks=maxi oints)'
13'
'Presence of ina'or ti�alt failure's
1; J ,..°i
p'.5-:.
4
�.
= r:.M
(severe erosion.=0'; no; erosion; `sabl'e4banks` i oinfs .
- :
=
ltoot'de tli aiid'densi on banks
p...,.. , h'.. " .,
`oints
no_visilile roots,,=0;.dense roots ttiiou' hout=rnax ,''_
_
15
=>Impact liy-agricultur`e;livesfoclt,'or tiinlier piroduct-ori
0-5*-'
3
_
(sUbstaritiaf'jrn acro; no evidence='max points)
_5
O=4
Presence of riffle=p64/kipple=poolcompl'exe's
p riffl'e's/n' le`sor oo1s=0; well-develo `ed=max -oints)
Habitat cpm Lexi �'`_°'.•
o - .-P,...
0=6 `
0-6
0-6;--
4
(little; or nohabitat=0; fre' ue"ntv"d habitats=max points
p?
'` 18 •_
Canopy coverage over, streambi& '.
s
(no shadirig,vegetation=0; continuous canopy max points):
19=
SuliArate e`mtieddedness;;=.`=
IVA*,
de"e T einliedded=0;loose stricture=maxpoints ;
Presence'of:stream in'verteb'rates`(see'page 4),:-
4
,0'— S F
2
(no'evidence, 0 'commofi;iftinerous types pints)
0_—
0-5, ..
Presence- of amphibians ... , ,..
(no'evidence=0 cotntnon; nuriier'ous, es=maxp outs :
-1
...22.
..•. ,,. ;,•. ." ;'; Pre'sence'of:fish-r:::f "•,._
= ,
evidence=O;,6omm(in;'iiiimdrous es=max' oints). .
"23'
Evidence:of "dlife'use.' '
0`=6
0.— 5
0`= 5
5
(no,'evidence=0 abun`d evidence=ma pints `.
Total Points Possible41100
100
t' 100}
�4.r ny.
x.<..
�.
TOTAL SiQORE (also enter on first page)
72
* These characteristics are not assessed in coastal streams. ,

NC DWO Stream Identification Form Version 4.11
Date: 5/22/2015
Project/site: Fernbrook
Latitude: 36.028341
Evaluator: A. Baldwin & N. Ronan
County: Forsyth
Longitude: -80.250814
Total Points:41.5
Stream Determination (circle one)
OtherStream A - 2
Stream is at least intermittent
Ephemeral Intermittent Perennial
e.g. Quad Name: Winston -Sale
if >_ 19 or perennial if>_ 30'
2
3
East and West
A. Geomorphology (Subtotal= 21.5
Absent
Weak
Moderate
Strong
12. Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
1
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
2
3
4. Particle size of stream substrate
0
1
2
3
5. Active/relict floodplain
0
1
2
3
6. Depositional bars or bench6s
0
1
2
3
7. Recent alluvial deposits
0
1
2
3
8. Headcuts
0
1
2
3
9. Grade control
0
0.5
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
No =
0
Yes = 3
a artificial ditches are not rated; see discussions in manual
B. Hvdroloqv (Subtotal = 11.5 )
12. Presence of Baseflow
0
1
2
3
13. Iron oxidizing bacteria
0
1
2
3
14. Leaf litter
1.5
1
0.5
0
15. Sediment on plants or debris
0
0.5
1
1.5
16. Organic debris lines or piles
0
0.5
1
1.5
17. Soil -based evidence of high water table?
Other = 0
No = 0
Yes = 3
C. Bioloav (Subtotal = 8.5
18. Fibrous roots in streambed 3
2
1 0
19. Rooted upland plants in streambed 3
2
1 0
20. Macrobenthos (note diversity and abundance) 0
1
2 3
21. Aquatic Mollusks 0
1
2 3
22. Fish 0
0.5
1 1.5
23. Crayfish 0
0.5
1 1.5
24. Amphibians 0
0.5
1 1.5
25. Algae 0
0.5
1 1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5
Other = 0
'perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Data point taken further upstream adjacent to PSA, residential lot immediately
upstream of DP locatio
with mowed understory and large trees along rigbt bank-
Sketchstormwater inputs relative to the downstream DP.
This reach of stream does
not bqve the reside
tial

USACE AID# DWQ # Site # SA — 3
Q STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name: City of Winston-Salem 2. Evaluator's name:
3. Date of evaluation: 9/3/2015 4. Time of evaluation: 8:47
A. Baldwin
5. Name of stream: UT to Perryman Branch
7. Approximate drainage area: 75 ac
9. Length of reach evaluated:
6. River basin: Yadkin
8. Stream order: First
200 ft 10. County:
11 Site coordinates (if known): Prefer in decimal degrees. 12. Subdivision name (if any): n/a
Latitude (ex. 34.872312): 36.031114 Longitude (ex. — 77.556611): -80.248723
Method location determined (circle): PS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location): See man.
(indicate on attached map)
tt,l i
14. Proposed channel work (if any): Removal of aerial existing 8" sewer line.
15. Recent weather conditions: Dry and warm, last measurable rain event was 0.03" on 8/31 and 0.03" on 8/24
16. Site conditions at time of visit: Sunny — Low 80's
17. Identify any special waterway classification known: _ Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters Nutrient Sensitive Waters _Water Supply Watershed (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES ® If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ©E NO 20. Does channel appear on USDA Soil Survey? ©E NO
21. Estimated watershed land use: 85% Residential % Commercial % Industrial % Agricultural
15% Forested _% Cleared / Logged % Other ( )
22. Bankfull width: 4 ft 23. Bank height (from bed to top of bank): 1 ft
24. Channel slope down center of stream: X % Flat (Oto 2%) % Gentle (2 to 4%) % Moderate (4 to 10%) % Steep (>10%
25. Channel sinuosity: _Straight X Occasional bends Frequent meander _% Very sinuous _Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on location, terrain,
vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points to each characteristic within the
range shown for the ecoregion. Page 3 provides a brief description of how to review the characteristics identified in the worksheet. Scores should
reflect an overall assessment of the stream reach under evaluation. If a characteristic cannot be evaluated due to site or weather conditions enter 0 in
the scoring box and provide an explanation in the comments section. Where there are obvious changes in the character of a stream under review
(e.g., the stream flows from a pasture into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form
used to evaluated each reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of
the highest quality.
Total Score (from reverse): 26
Comments:
Evaluator's Signature:Ao� Date:
�f 9/3/2015
This channel evaluation form is intended to be used only as a guide to assist landowners and environmental professionals in gathering the
data required by the United States Army Corps of Engineers to make a preliminary assessment of stream quality. The total score resulting
from the completion of this form is subject to USACE approval and does not imply a particular mitigation ration or requirement. Form
subject to change — version 06/03. To Comment, please call 919-8776-8441 x 26.
1

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#., •
CHARACtERISTIC5
ECUREGION
POINT RANGE
,' SCORE ,
Coastal
Piedmont`
Mountain_`
1`
Presence of tlow /'pe'rsiste'nt pools in stream
.
(no-flow_or sataiatiori -0; strong flow=max oints)
0.=5
6-4
0-5
3
Evidence of'past liuman alteration '
(extensive alteration=O:no aliq'-r on=niax oints
0 = 6 ,
0—. 5
0-5
1
`3 ':
_ ': Riparian zone,
0-6
0 - 4'
0 = 5
0
no buffer -0; coriti ous, oints wide buffer.=max
4
Evidence of :nutrient or 'chemical dischargers .
(extensive discharges=0; rio discharges=max points):.
0-5
0-4
0-4
1
5
Gropndwate'r• discharge
-
(no discharge=0; s rings, see s, wetlands, etc.=max ' Dints)
0— 3
0-4-
0-4
1
!- ri
-6:
`�_ . Presence of'adjacept floodplain '
�
_• - =
(rio flood lain=0; extensive flood lain=inaic oints)
0=4
0-4_
0-2
1
=
7..
Entreneliment/floodplanaccess
0-4,
1
w�pa,
(deep ei tienclied=0 .fie uent flooding=max Dints)
0--.5
0-2
8
= Presenceyof.adjacent we'''tlands
(no,wetlands=0; laige,adjacentwetlands=max' Dints
0= 60-4
_
0— 2
0
' "
0= 5
0= 4 ..
0— 3
1
ext6nsive.channelization-0; natuial.meandet=max' oirits
-,
Na :
SedimentAiiipitt` '
pli= irifs
(extensive' de' ;osition=0 little or no: sedimenl==max o
a:
0-,5._..
0-4.
0=4�
1
11 .'
Size &diversity of'channel bed-sulistrate .,
NA*
` `'
0 4
0.= 5
1
(fine; homogene'o`us='Q large; diverse sizes -max Dints)
I2
= Evidence`ofclangel iiicisioi►wor;wideiin-
-F; „(dee_' lyrncised-0; stable.bed &:banks=rriax ' Dints)
r
`
:`1"3ti
_ Pre§enceof'ma'oraankfailures`'-:,
-(severe erosion=Q;'no'erosion; salil'e.banks=max oin'ts);-'
: ,.,.,. , ..'.
, ' _
14'`
:`'. _ '.' R—&d`e'pth and''density on li ki- "` T-
., .. ,.
0=3
0-4,
0-5
2
"visible 'roofs..=0; dense roots throu hout=rriax points); ;.
"15
Impact by agriciilture;'livestoc 'or timber roductiou
0-4
04— 5
3
(substantial°impact=0;'no a dence-max points)
0 — 5.
.-
1,6-
Presence-of.riffle-pool/ripple-pool complexes
(no, riffles%rip' les or oo19=0 'well-develo ` ed=max ' oints ,
17`'`
_ - :FlabifAt,6iolexity;
fiequerit;..variedliabitats
E ,.,...,
(little or iio.liabifat=0" 7riax points
18%"
Canopy :coverage over ;
^streambed.
no shadin g ve etation 0 cotitmi ons cavo , max omts
(` g' g Ply. p )-
0.- 5
0"5
. 0 — 5,
1
Substrafe emlied"dedii ss - J.'.
'
NA*
0,'4
0 —4
1
.(dee' h embedded=0;-loose `structure=inax' oints)'
2.0
Presence`of st "ream invedebr' ates (s'e'e page 4)'
(no evidence=0-"common; numerous • es=max points).
0—4,
0-5
0 = 5
0
'
G5
`21
`'21
; -p amphibians
0-4
0-4
0'-4
1
.z
(no evidence=0; common, numerous - -s max oints).
22
Presence of fish" -:.
0-4-
0,-4`.:
0-4:
0
(no evidence=0;' common; numerous ' es=max Dints) .
23"
Evidence of=wildlife:iise"0-6.-
0 =
5'
1
nQevidenc_aburidant,evideiice=max Dints
e=0
Total Points Possible
100`
l00
1.00
y-
TQ�AL SCORE enter on first
,y
i
4
26
(also page}
* These characteristics are not assessed in coastal streams.

NC DWQ Stream Identification Form Version 4.11
Date: 9/3/2015
Project/Site: Fernbrook
Latitude: 36.031114
Evaluator: A. Baldwin & N. Ronan
County: Forsyth
Longitude: -80.248723
Total Points: 25
Stream Determination (circle one)
OtherStream A - 3
Stream is at least intermittent
Ephemeral Intermittent Perennial
P
e. Quad Name:
9 Winston -Sale
if 2: 19 or perennial if >_ 30*
2
3
East and West
A. Geomorphology Subtotal = 9
Absent
Weak
Moderate
Strong
18 Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
1
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
1
2
3
4. Particle size of stream substrate
0
1
2
3
5. Active/relict floodplain
0
1
2
3
6. Depositional bars or benches
0
1
2
3
7. Recent alluvial deposits
0
1
2
3
8. Headcuts
0
1
2
3
9. Grade control
0
0.5
1
1.5
10. Natural valley
0
0.5
1
1.5
11. Second or greater order channel
chann
No = 0
Yes = 3
a artificial ditches are not rated; see discussions in manual
B. Hydrology (Subtotal = 9.5 )
12. Presence of Baseflow
0
1
2
3
13. Iron oxidizing bacteria
0
1
2
3
14. Leaf litter
1.5
1
0.5
0
15. Sediment on plants or debris
0
0.5
1
1.5
16. Organic debris lines or piles
0
0.5
1
1.5
17. Soil -based evidence of high water table?
0
No = 0
Yes = 3
1.5
C. Biology (Subtotal = 6.5
18. Fibrous roots in streambed
3
2
1
0
19. Rooted upland plants in streambed
3
2
1
0
20. Macrobenthos (note diversity and abundance)
0
1
2
3
21. Aquatic Mollusks
0
1
2
3
22. Fish
0
0.5
1
1.5
23. Crayfish
0
0.5
1
1.5
24. Amphibians
0
0.5
1
1.5
25. Algae
0
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL = 1.5 Other = 0
*perennial streams may also be identified using other methods. See p. 35 of
manual.
Notes: Data point taken immediately upstream
of existing
sewer crossing. Riparian
area on both banks is
maintained residential landcaping-
Sketch:
There is a silhstantial
amount of microstegium
in the stream
chann

WETLAND DETERMINATION DATA FORM- Eastern Mountains and Piedmont Region
Project/Site: Fernbrook / City of Winston-Salem City/County: Winston-Salem/Forsytb Sampling Date: 5/22/2015
Applicant/Owner: City of Winston-Salem State: NC Sampling Point: WA - WET
Investigator(s): A. Baldwin & N. Ronan Section, Township, Range:
Landform: (hillslope, terrace, etc.) Floodplain Local Relief (concave, convex, none): none Slope (%): 0
Subregion (LRR or MLRA). LRR - P Lat: 36.024740 N Long: 80.252210 W Datum: NAD 83
Soil Map Unit Name: Louisburg -Wedowee complex 15-25% NWI Classification: none
Are climatic/hydrologic conditions on the site typical for this time of year? Yes l] No ❑ (If no, explain in Remarks.)
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ significantly disturbed? NO Are "Normal Circumstances" present? Yes NEI ❑
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ naturally problematic? NO (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS - Attach site
Hydrophytic Vegetation Present? Yes l] No ❑
Hyd ric Soil Present? Yes O No ❑
Wetland Hydrology Present? Yes l] No ❑
Remarks:
I_Fkr _hl _-7i1 riTr1`/
sampling point locations, transects, Important reatures, 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 (136)
❑ Surface Water (Al)
❑
Water -Stained Leaves (139)
❑
Sparsely Vegetated Concave Surface (B8)
O High Water Table (A2)
❑
Aquatic Fauna (1313)
❑
Drainage Patterns (1310)
El Saturation (A3)
❑
True Aquatic Plants (814)
❑
Moss Trim Lines (B16)
❑ Water Marks (Bl)
❑
Hydrogen Sulfide Odor (Cl)
O
Dry -Season Water Table (C2)
❑ Sediment Deposits (112)
O
Oxidized Rhizospheres on Living Roots (0)
❑
Crayfish Burrows (C8)
❑ Drift Deposits (133)
❑
Presence of Reduced Iron (C4)
❑
Saturation Visible on Aerial Imagery (C9)
❑ Algal Mat or Crust (134)
❑
Recent Iron Reduction in Tilled Soils (C6)
2
Stunted or Stressed Plants (Dl)
❑ Iron Deposits (135)
❑
Thin Much Surface (0)
O
Geomorphic Position (D2)
❑ Inundation Visible on Aerial Imagery (87)
❑
Other (Explain in Remarks)
❑
Shallow Aquitard (D3)
❑
Microtopographic Relief (D4)
l]
FAC -Neutral Test (D5)
Field Observations:
Surface Water Present? Yes ❑ No
O
Depth (inches):
Water Table Present? Yes l] No
❑
Depth (inches): 11
Saturation Present? Yes 0 No
❑
Depth (inches): 9
Wetland Hydrology Present? Yes p 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 Region - Version 2.0

VEGETATION (Five strata) - use scientiTlc names OT plants.
sampnng Point: WA- WLI
Absolute Dominant
Indicator
Dominance Test Worksheet:
Tree Stratum (Plot size: 30 ft radius )
% Cover Species?
Status
Number of Dominant Species
1.
Carpinus caroliniana
70 y
FAC
That Are OBL, FACW, or FAC: 5
(A)
2.
Acer rubrum
10
FAC
Total Number of Dominant
3.
Liquidambarstyraciflua
5
FAC
Species Across All Strata: 5
(B)
4.
Percent of Dominant Species
That Are OBL, FACW, or FAC: 100%
(A/B)
5.
6.
7,
Total % Cover of: Multiply by:
OBL species 40 x 1= 40
85 =Total Cover
50% of total cover:
42.5
20% of total cover:
17
FACW species 60 x2= 120
Sapling
Stratum (Plot size: 30 ft radius )
FAC species 230 x3= 690
1.
Carpinus caroliniana
80 y
FAC
FACU species 5 x4= 20
2.
Acer rubrum
5
FAC
UPL species 0 x5= 0
Column Totals: 335 (A) 870
(B)
3. Liquidambarstyraciflua 5 FAC
4. Asiminia triloba 5 FAC
Prevalence Index = B/A = 2.6
5.
6.
Hydrophytic Vegetation Indicators:
7.
❑ 1- Rapid Test for Hydrophytic Vegetation
95 = Total Cover
E) 2 - Dominance Test is > 50%
50% of total cover:
47.5
20% of total cover:
19
❑ 3 - Prevalence Index is:5 3.0'
Shrub Stratum (Plot size: 30 ft radius )
❑ 4 - Problematic Hydrophytic Vegetation' (Explain)
1.
Acer rubrum
30 Y
FAC
2.
Prunus serotina
5
FACU
' Indicators of hydric soil and wetland hydrology must
3.
Liquidambarstyraciflua
5
FAC
be present, unless disturbed or problematic
4.
5.
Definitions of Vegetation Strata:
6.
7.
Tree - Woody plants, excluding woody vines,
approximately 20 ft (6 m) or more in height and 3 in. (7.6
40 = Total Cover
50% of total cover:
20
20% of total cover:
g
cm) or larger in diameter at breast height (DBH).
Herb Stratum (Plot size: 30 ft radius )
Sapling - Woody plants, excluding woody vines,
1.
Boehmeria cylindrica
60 Y
FACW
approximately 20 ft (6 m) or more in height and less than 3
in. (7.6 cm) DBH.
Shrub - Woody plants, excluding woody vines,
2. Glyceria striata 40 y OBL
3. Porthenocissus quinquefolia 5 FAC
4.
approximately 3 to 20 ft (1 to 6 m) in height.
Herb -All herbaceous (non -woody) plants, including
5•
6.
herbaceous vines, regardless of size. Includes woody
7,
plants, except woody vines, less than approximately 3 ft (1
m) in height.
8
Woody vine - All woody vines, regardless of height.
9.
10.
11.
12.
105 =Total Cover
50% of total cover:
52.5
20% of total cover:
21
Hydrophytic
Woody Vine Stratun (Plot size: 30 ft radius
Vegetation Yes I] No ❑
1.
Lonicerajaponica
10
FAC
Present?
2.
3.
4.
5.
10 =Total Cover
50% of total cover:
5
20% of total cover:
2
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont Region - Version 2.0

SOIL
)rofile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators).
Depth
Matrix
Dark Surface (S7)
Redox Features
Histic Epipedon (A2)
(inches)
Color (moist) %
Color (moist)
% Type'
Loc' Texture
3
10 YR 4/2 90
5 YR 4/6
10 C
PL SiL
12
10 YR 5/2 60
5 YR 4/6
30 C
M CL
2 cm Muck (A30) (LRR N)
❑
5 YR 4/6
10 C
PL
20+
10 YR 5/4 75
7.5 YR 5/8
15 C
M SL
Redox Depressions (FS)
❑
2.5 YR 5/2
10 D
M
'Type C = Concentration, D = depletion, RM = Reduced Matrix, CS = Covered or Coated Sand Grains
Hydric Soil Indicators:
❑
Histosol (Al)
❑
Dark Surface (S7)
❑
Histic Epipedon (A2)
❑
Polyvalue Below Surface (S8) (MLRA 147,148)
❑
Black Histic (A3)
❑
Thin Dark Surface (S9) (MLRA 147,148)
❑
Hydrogen Sulfide (A4)
❑
Loamy Gleyed Matrix (F2)
❑
Stratified Layers (AS)
Depleted Matrix (F3)
❑
2 cm Muck (A30) (LRR N)
❑
Redox Dark Surface (F6)
❑
Depleted Below Dark Surface (All)
❑
Depleted Dark Surface (F7)
❑
Thick Dark Surface (Al2)
❑
Redox Depressions (FS)
❑
Sandy Mucky Mineral (Sl)
❑
Iron -Manganese Masses (F12) (LRR N, MLRA 136)
(LRR N, MLRA 147,148)
❑
Sandy Gleyed Matrix (S4)
❑
Umbric Surface (F13) (MLRA 136,122)
❑
Sandy Redox (S5)
❑
Piedmont Floodplain Soils (F19) (MLRA 148)
❑
Stripped Matrix (S6)
❑
Red Parent Material (F21) (MLRA 127,147)
(if observed):
(inches)
Sampling Point: WA- WET
Remarks
—10% small gravel
2Location: PL= Pore Lining, M = Matrix
Indicators for Problematic Hydric Soils3:
❑ 2 cm Muck (A10) (LRR S)
❑ .Coast Prairie Redox (A16) (MLRA 136,147)
❑ Piedmont Floodplain Soils (F19)
(MLRA 136,147)
❑ Very Shallow Dark Surface (TF12) (LRR TU)
❑ Other (Explain in Remarks)
3Indicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes p No ❑
US Army Corps of Engineers Eastern Mountains and Piedmont Region - Version 2.0

WETLAND DETERMINATION DATA FORM - Eastern Mountains and Piedmont Region
Project/Site: Fembrook / City of Winston-Salem City/County: Winston-Salem/Forsyth Sampling Date: 5/22/2015
Applicant/Owner: City of Winston-Salem State: NC Sampling Point: WA - UP
Investigator(s): A. Baldwin & N. Ronan Section, Township, Range:
Landform: (hillslope, terrace, etc.) Toe Slope Local Relief (concave, convex, none): none Slope (%): 0
Subregion (tRR cr MLRA) LRR - P Lat: 36.024750 N Long: 80.252162 W Datum: NAD 83
Soil Map Unit Name: Louisburg -Wedowee complex 15-25% NWI Classification: none
Are climatic/hydrologic conditions on the site typical for this time of year? Yes p No ❑ (If no, explain in Remarks.)
Are Vegetation ❑ , Soil ❑ , or Hydrology ❑ significantly disturbed? NO Are "Normal Circumstances" present? Yes Np ❑
Are Vegetation ❑ ' , Soil ❑ , or Hydrology ❑ naturally problematic? NO (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS - Attach site map showing sampling point locations, transects, Important reatures, etc.
Hydrophytic Vegetation Present? Yes 0 No ❑ Is the Sampled Area
Hydric Soil Present? Yes ❑ No [D within a wetland? Yes ❑ No 0
Wetland Hydrology Present? Yes ❑ No p
Remarks:
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two required)
Primary Indicators (minimum of ane is required: check all that apply):
❑
Surface Soil Cracks (136)
❑ Surface Water (Al)
❑
Water -Stained Leaves (89)
❑
Sparsely Vegetated Concave Surface (138)
ED High Water Table (A2)
❑
Aquatic Fauna (1313)
❑
Drainage Patterns (1310)
ID Saturation (A3)
❑
True Aquatic Plants (1314)
❑
Moss Trim Lines (616)
❑ Water Marks (131)
❑
Hydrogen Sulfide Odor (Cl)
❑
Dry -Season Water Table (C2)
❑ Sediment Deposits (132)
❑
Oxidized Rhizospheres on Living Roots (0)
❑
Crayfish Burrows (CB)
❑ Drift Deposits (133)
❑
Presence of Reduced Iron (C4)
❑
Saturation Visible on Aerial Imagery (C9)
❑ Algal Mat or Crust (134)
❑
Recent Iron Reduction in Tilled Soils (C6)
❑
Stunted or Stressed Plants (Dl)
❑ Iron Deposits (65)
❑
Thin Much Surface (0)
❑
Geomorphic Position (D2)
❑ Inundation Visible on Aerial Imagery (67)
❑
Other (Explain in Remarks)
❑
Shallow Aquitard (D3)
❑
Microtopographic Relief (D4)
2
FAC -Neutral Test (DS)
Field Observations:
Surface Water Present? Yes ❑ No
p
Depth (inches):
Water Table Present? Yes ❑ No
O
Depth (inches):
Saturation Present? Yes ❑ No
El
Depth (inches):
Wetland Hydrology
Present? Yes ❑ No O
(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 Region - Version 2.0

VEGETATION (Five Strata) - Use scientitic names of plants.
sampling Point: WA -lir
Absolute
Dominant
Indicator
Dominance Test Worksheet:
Tree
Stratum (Plot size: 30 ft radius )
% Cover
Species?
Status
Number of Dominant Species
1.
Carpinus caroliniana
80
y
FAC
That Are OBL, FACW, or FAC: 7
(A)
2.
Total Number of Dominant
3
Species Across All Strata: 8
(B)
4.
Percent of Dominant Species
That Are OBL, FACW, or FAC: 88%
(A/B)
5.
6.
7.
Total % Cover of: Multiply by:
80
= Total Cover
0131 -species 0 x 1= 0
50% of total cover:
40
20% of total cover:
16
FACW species 5 X2= 10
Sapling Stratum (Plot size: 30 it radius )
FAC species 120 x3= 360
1.
Carpinus caroliniana
10
y
FAC
FACU species 5 x4= 20
UPI -species 0 x5= 0
2.
3,
Column Totals: 130 (A) 390
Prevalence Index = B/A = 3.0
(B)
4.
5.
6.
Hydrophytic Vegetation Indicators:
7.
❑ 1- Rapid Test for Hydrophytic Vegetation
10
= Total Cover
171 2 - Dominance Test is > 50%
50% of total cover:
5
20% of total cover:
2
❑ 3 - Prevalence Index is <_ 3.0'
Shrub
Stratum (Plot size: 30 ft radius )
❑ 4 - Problematic Hydrophytic Vegetation' (Explain)
1.
Acer ruhrum
5
y
FAC
2
' Indicators of hydric soil and wetland hydrology must
3.
be present, unless disturbed or problematic
4.
S.
Definitions of Vegetation Strata:
6.
7.
Tree - Woody plants, excluding woody vines,
5
=Total Cover
approximately 20 ft (6 m) or more in height and 3 in. (7.6
'
50% of total cover:
2.5
20% of total cover:
1
cm) or larger in diameter at breast height (DBH).
Herb Stratum (Plot size: 30 ft radius )
Sapling - Woody plants, excluding woody vines,
1.
Boehmeria cylindrico
5
y
FACW
approximately 20 ft (6 m) or more in height and less than 3
in. (7.6 cm) DBH.
Shrub - Woody plants, excluding woody vines,
2. Compsis radicons 5 y FAC
3. Parthenocissus quinquefolia 5 y FAC
4.
Phytolacco americana
5
y
FACU
approximately 3 to 20 ft (1 to 6 m) in height.
S.
Rubus sp.
5
y
FAC
Herb - All herbaceous (non -woody) plants, including
herbaceous vines, regardless of size. Includes woody
6.
7
plants, except woody vines, less than approximately 3 ft (1
m) in height.
8.
9.
Woody vine - All woody vines, regardless of height.
10.
11.
12.
25
=Total Cover
Hydrophytic
50% of total cover: 12.5 20% of total cover: 5
Woody
Vine Stratun (Plot size: 30 ft radius
Vegetation Yes 0 No ❑
1.
Lonicerajaponica
10
FAC
Present?
2.
3.
4.
S.
10
=Total Cover
50% of total cover:
5
20% of total cover:
2
Remarks: (Include photo numbers here or on a separate sheet.)
US Army Corps of Engineers Eastern Mountains and Piedmont Region - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators).
Depth Matrix Redox Features
(inches) Color (moist) % Color (moist) % Type' Loc2 Texture
7 10 YR 4/4 100 SL
15+ 10 YR 5/3 80 5 YR 4/6 15 C PL CL
5 YR 5/2 5 D M
Sampling Point: WA - UP
Remarks
'Type C = Concentration, D = depletion, RM = Reduced Matrix, CS = Covered or Coated Sand Grains
2Location: PL = Pore Lining, M = Matrix
Hydric Soil Indicators:
Indicators for Problematic Hydric Soils3:
❑
Histosol (Al)
❑
Dark Surface (S7)
❑ 2 cm Muck (A10) (LRR S)
❑
Histic Epipedon (A2)
❑
Polyvalue Below Surface (S8) (MLRA 147,148)
❑ Coast Prairie Redox (A16) (MLRA 136,147)
❑
Black Histic (A3)
❑
Thin Dark Surface (S9) (MLRA 147, 148)
® Piedmont Floodplain Soils (F19)
❑
Hydrogen Sulfide (A4)
❑
Loamy Gleyed Matrix (F2)
(MLRA 136, 147)
❑
Stratified Layers (AS)
❑
Depleted Matrix (F3)
❑ Very Shallow Dark Surface (TF12) (LRR TU)
❑
2 cm Muck (A10) (LRR N)
❑
Redox Dark Surface (F6)
❑ Other (Explain in Remarks)
❑
Depleted Below Dark Surface (All)
❑
Depleted Dark Surface (F7)
❑
Thick Dark Surface (Al2)
❑
Redox Depressions (F8)
❑
Sandy Mucky Mineral (Sl)
❑
Iron -Manganese Masses (1`12) (LRR N, MLRA 136)
(LRR N, MLRA 147,148)
❑
Sandy Gleyed Matrix (54)
❑
Umbric Surface (F13) (MLRA 136,122)
3Indicators of hydrophytic vegetation and
❑
Sandy Redox (55)
❑
Piedmont Floodplain Soils (1`19) (MLRA 148)
wetland hydrology must be present,
❑
Stripped Matrix (S6)
❑
Red Parent Material (F21) (MLRA 127,147)
unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
I
Depth
(inches)
Hydric Soil Present? Yes ❑ No 0
US Army Corps of Engineers Eastern Mountains and Piedmont Region - Version 2.0

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ATTACHMENT
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD): 9/21/2015
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES
AT DIFFERENT SITES)
State: NC County/parish/borough: Forsyth City: Winston-Salem
Center coordinates of site (lat/long in degree decimal format): Lat. °
Pick List, Long. ° Pick List. Lat. 36.027712 N Long. 80.250489 W
Universal Transverse Mercator: Zone 17
Name of nearest waterbody: UT to Perryman Branch
Identify (estimate) amount of waters in the review area:
Non -wetland waters: 315 linear feet: 4 width (ft) and/or n/a acres.
Cowardin Class: Riverine Upper Perennial/Intermittent Streambed
Stream Flow: Perennial and Intermittent
Wetlands: 0.294 acres.
Cowardin Class: Palustrine Forested
Name of any water bodies on the site that have been identified as Section 10
waters: n/a
Tidal:
Non -Tidal:
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
E

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.
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:
9

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
applicant/consultant:
® Data sheets prepared/submitted by or on behalf of the
applicant/consultant.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑X 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: 24K stop -Salem West and East
©USDA Natural Resources Conservation Service Soil Survey. Citation:
Forsyth County 1976
[21 National wetlands inventory map(s). Cite name:FWS•CONUS Wetland Data Forysth
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100 -year Floodplain Elevation is:
of 1929)
County 1994
(National Geodectic Vertical Datum
® Photographs: ® Aerial (Name & Date): NAIP Forsyth County 2013
or ® Other (Name & Date): Project Area Photos of Jurisdictional Features
5/22/2015
❑ Previous determination (s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified by the Corps and should not be relied upon for
later jurisdictional determinations.
Signature and date of
Regulatory Project Manager
(REQUIRED)
10
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining
the signature is impracticable)

- 1'rETLAND
INV I1,1=729.40-ErDIP(NEI
Temporary Impacts: 0.04 ac
Wetland A, W1
UTILITY DESIGN APPROVED
Waco s Sewer
UOltun Di— I)
Approval by the Utilitm Dirccmr of 5 -I,,� and
mfim— depicted in thea pia does wl
canstiW Wpm,al fm my other ptapose then that sat
froth in Section 6d of the Wmer System Policy atld
Smut, 36 of the Sewer System Policy of the
City'Coony Utility Commission To the ntrnt othm
Pcmtiw. hc—, Permtsswm m the IJte mast ff
,Wimd to complete this pmje such ate qp ificalll
nm g—d by N, approval and must be obtai-d by
the Develop, -&m hts desi,—
CONNECTTO,EXISTING PRK \\ \ NOTES:
CONCRETE MANFi�hE � \
BY CORING AND IIJSTALLI \ t. BUFFER SHOWN IS FOR THE PURPOSE OF EROSION CONTROL PERMITTING.
FlE%IBLE MANHOLE CONN 2. PLACE ROCK WALL ALONG WESTERN EDGE OF EASEMENT. INSTALL FILTER FABRIC BEHIND WALL TO
(SEE DETAIL 2/91 PREVENT LOSS OF SOIL THROUGH ROCKS. BACKFILL, REGRADE. AND GRADE SMOOTH FOR
ADEQUATE VEHICLE PASSAGE AND DRAINAGE. ROCK WALL SHALL RUN FROM STATION 4+25 TO 7+25.
+ + ISEE DETAIL 6/101
3. GRADE PERMANENT EASEMENT FOR PASSAGE OF MAINTENANCE TRAFFIC AND TO ADEQUATELY -
„ DRAIN. /
4. INSTALL EROSION CONTROL MATTING ON 3:1 SLOPES OR GREATER, AS APPROVED BY ENGINEER. /
5. BED PIPE APPROPRIATELY PER DETAIL AND CRY STANDARDS. /
Permanent Impacts: 0.09 ac A. STREAM A, A-2 WAS NOT SURVEYED IN ITS ENTIRETY BECAUSE IT WAS
w Wetland A, W2 OUTSIDE THE LIMITS OF THE 40 FT CORRIDOR OF THE PIPE
+ + w \
ALIGNMENT THAT WAS SURVEYED. \\ STONE OOT�ryp �/
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\ \ Bank (See note A.)
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\ / / WATERS OF THE US: IMPACT MAP
/ DECEMBER 14, 2015
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SURVEY COMPLETED BY
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GREENSBORO, NC 27407
TELE: 336-697-2637
i(SEE DETAIL 2/1 1
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RE -INSTALL EX IB HDPE
BASED ON RNAL'G y�
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\,SEF`ETAIL6/Ilt-- PROPERMANENT PIPE l �•t
PROTECRO�•.
(SEE DEMLALL1)
\ / / WATERS OF THE US: IMPACT MAP
/ DECEMBER 14, 2015
JCS
/ SHEET 1 OF 3
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50
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Project Number: 175613066
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0 5 of 12

/ STONE CUTLETTTT(
(SEE DETML 3/11)
/ SRT FENCE TYP
(SEE DETAR. 2/11)
/ Jim J
0
IDM OFF 18' Ry
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HA -3 / A / / IsE€DETAIIL —
y A PIPE OUTLET / % / i
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- N 831420.09
EROSION CONHM�OL�
12�r 18' RCT. SWALE
`\
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DITCH SLOPE
MIN. SLOPE 0.5% - 1
CHECK DAM, TYP .nit
(SEE DETAILA/11) I
SAN MH 7
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N 831779.65
E 1630313.97
mora— W, BAR
TSEE DETAIL 7/111
"I" {T
"N
REMOVE AND STORE FENCE,
COORDINATE WITH HOMEOWNER
FOR STORAGE LOCATION
ran
=4v
0 7 4' 8'
— WATERS OF THE US: IMPACT MAP
DECEMBER 14, 2015
--- I � JCS
- -_ — SHEET 2 OF 3
UT/L/TY DESIGN APPROVED
W—& Sewer
Unli-Arccw Del,
Approval by the Unhno Di-- of the a— arM
,ewer bliss -c— dcpiaed in three Plans doa nm
Jmc apr—1 fw any othc, pwse pothan chat si t
I'M m Section M of the W1w Sys— Policy said
SecUnn 36 of the Scw Sy Policy of the
Cary/Coomy Utility Comm To the cesem other
permdc li—a,s, peau th Iik, most be
obtained to complae this projca. such arc sr—r—lly
ant gamed by this approval and muse be obtainal by
the Developer and/m his desig cc.
p,nn yoraw,e wear &. s.n plan: en,a na
c aM^vval fm coronon ApJno 1
a Min formal- me
pncnt, Fi lire, a
lira w h q—Pda t RFu J;
i,vv dciao,
f s7ian wdI
rclJ, City cia , r—tal P.vJuipsrian in this InnJttc
..turweva.
C'f1Y Q N'1Na"rt1NaAlEM
BY:
SURVEY COMPLETED BY
1C WALLER d ASSOCIATES, PC
7-L DUNDAS CIRCLE
GREENSBORO, NC 27407
TELE: 336-697-2637
NOTES:
■■■■■■
■■■N
■■ NNI
n■■�
■N nN
■■ ■■■■
23LF OF I8• RCP
N
I. LOCATE STONE OUTLETS IN NATURAL DRAINAGE BUT NO MORE THAN 150 LF IN
O
0 1.00%
°
SPACING.
STREAM A-2 SAN MH 6 .'
■
2. PILPE INLET AND OUTLET STABILIZATION SHALL BE PERMANENT. CONTRACTOR TO
PLACE EXCAVATED ROCK ON BOTH SIDES OF RLL AREA
R33���FYa
-Igg4
STK 17.65
N■ ■■■ n■■■■■■■■■N■N■■■
3. INSTALL EROSION CONTROL MATTING ON 3:1 SLOPES OR GREATER, AS APPROVED BY
■ ■ ■
E 183
ENGINEER.
■M■ ■■■■ ■■■■■■■■■■■■ME■■■■■
/
W N
4. BED PIPE APPROPRIATELY PER DETAIL AND CrfY STANDARDS.
U
/
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UT/L/TY DESIGN APPROVED
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SEE SHEET 6
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SURVEY COMPLETED BY I. RE-ESTABLISH DITCH LINE ALONG RIGHT-OF-WAY FROM STA 23+00 TO STA 26+50. - \0 tiE _ o N
f/T/LnT DMGNA,PPROVED 1C WALLER 8 ASSOCIATES, PC 2. REMOVE AND REINSTALL MAILBOXES IN EQUAL OR BETTER CONDITION."—
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Warr& Sewer 3. REMOVE AND REPLACE CATCH BASIN AND STORM PIPING AT STA 22+90 SAN MH 13 _ SEWER CONNECTION cd
7-L DUNDAS CIRCLE 4. COORDINATE WITH HOMEOWNER PRIOR TO THE REMOVAL OF LANDSCAPING AND IRRIGATION STA: 29+74 .
GREENSBORO. HC 27607 WITHIN THE RIGHT-OF-WAY AND CONSTRUCTION EASEMENTS. RETURN REMOVED ITEMS TO THE I 183247666 TCF (SEE DETAILN5/9) U O ( I I g
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5. MAINTAIN DRIVEWAY ACCESS AT ALL TIMES FOR RESIDENTS SILT FENCE -. { O
npprov.I Isv 11m Lahues Duecum of rhe w.Im a�a 6. ALL CONCRETE REPLACEMENT SHALL BE TO THE NEAREST EXISTING JOINT. (SEE DETAIL 2/111 Z
scwm m(iaummure playa 7. REINSTALL WATER METERS WITHIN THE CONSTRUCTION TRENCH TO THE RIGHT-OF-WAY LINE. ., - y �Y f -e
degcled m Ihx pl..—d' nd Approval ofhme warm&. 'tay Plam dso nm -
am approval for any ohm prop— hen ll, .m m•wrw,l rwc . App 1 of 8. ABANDON PRIVATE PUMP AND MANHOLE BY REMOVING THE TOP THREE FEET AND BACKFILLING
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Smion 36 of S-he SSymmo Polity of he °�'"racn•Prm"rm mimx6cFi""'"F ofco",m,cu""u;n CLEANOUT AND RECONNECT EXISTING SEWER. 4+20 a 00 00 1' 1+70
CisviC—V Urih. Cm. To he -1 ohL, 'n` Croy a y fi.i,l pamclpo.—w.vmirm 9. CONFIRM LOCATION OF EXISTING CLEANOUT AND INSTALL NEW SEWER CONNECTION. WATERS OF THE US: IMPACT MAP
wna.ae�m. r the like move h pmmiacions mmils, 10. COORDINATE WITH HOMEOWNER PRIOR TO SETTING SEWER CONNECTION INVERT AT EXISTING 0 2040, BY
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I'=40H
MANHOLE. CONFIRM INVERT.
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the OcveLopm _his d.ienm. nIr 112. RECONNECT DISTURBED WATER SERVICES ACCORDING TO DETAIL 7/10. SHEET 3 OF 3
13. BED PIPE APPROPRIATELY PER DETAIL AND CITY STANDARDS.
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