20170031 Ver 1_Jurisdictional Determination Request_20160324

����� /�RG�DIS ���_��y�,����,s��t�a����
for natural and
built assets
Mr. David Bailey
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Subject:
Request for a Jurisdictional Determination of Waters of the United — Three Low
Impact Bridge Sites, Rockingham County, NC.
Dear Mr. Bailey:
ARCADIS has performed a stream and wetland delineation at three low impact
bridge sites in Rockingham County, NC for the North Carolina Department of
Transportation (NCDOT). NCDOT is proposing to replace these bridges. Information
for each site, including a brief site description is attached.
The three sites are:
Rockingham County
. Bridge 07 on SR 2427 (Benaja Road) over Benaja Creek (17BP.7.R.100)
. Bridge 39 on SR 2316 (Bethany Road) over Jacobs Creek (17BP.7.R.101)
• Bridge 283 on SR 2686 (Richardson Drive) over Little Troublesome Creek
(176P.7.R.104)
This letter serves as a formal request for a Jurisdictional Determination for each site.
If you have any questions or concerns, please contact me either by phone or email.
Sincerely,
ARCADIS US
,
�� / �r�
/
Robert Lepsic, PWS
Senior Scientist
Copies:
Nicole Thompson - NCDOT
File
Imagine the result
ARCADIS US
801 Corporate Center Drive
Suite 300
Raleigh
North Carolina 27607
Tel [phone]
Fax [phone]
www.arcadis-us.com
WATER
Date:
May 16, 2016
Contact
Robert Lepsic
Phone:
919.415.2278
Email:
robert.lepsic@arcadis-
us.com
Our ref:
NC612002.00000
ARCADIS US
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U
MAY24�016
DEiJR - WATER ReSOURCES
TRANSPORTATION PEPMITTING UNIT

Bridge 39 over Jacobs Creek on SR 2316 (Bethany Road)
17BP.7.R.101
Bridge 39 is located approximately 10 miles west of Reidsville near the Bethany Road — Honeysuckle
Road intersection. There are three perennial streams, one intermittent stream and one wetland located
in the study area.
SA is an intermittent stream that originates at a spring/pipe in the ground within the study area. It flows
parallel to SR 2316 through a brushy area dominated by Kudzu before entering SB. 56 (perennial)
originates in the same area as SA. Downstream of the confluence with SA, 56 flows parallel to RS 2316
through a mature woodland. SB goes below ground before entering Jacobs Creek. SC (Jacobs Creek)
flows roughly south to north across the study area. It was high and turbid during the site visit. SD
(perennial) originates north of the study area and flows through a mature woodland.
WA is a small seep entering SD from the north. Vegetation is dominated by herbaceous species.
D����d�
D
MAY 2 4 2016
DEiJR • WATER RESOIiRCES
TRANSPORTATION PERMITTING UNIT

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N SITE LOCATION
o �,000 2,00o Project No. 17BP.7.R.101 FIGURE
Feet Bridge No. 39 over Jacobs Creek �
1 inch = 1,000 feet on SR 2316
Rockingham County, NC

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AQUATIC FEATURES
Project No. 17BP.7.R.101
Bridge No. 39 over Jacobs Creek
on SR 2316
Rockingham County, NC
FIGURE
3

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SOILS
aoo Project No. 176P.7.R.101
� Feet Bridge No. 39 over Jacobs Creek
on SR 2316
Rockingham County, NC
FIGURE
�❑
r.

WETLAfVD DETERMINATION DATA FORM — Eastern Mountains and Piedmont
ProjecUSite: Bridge No. 039 on SR 2316 Bethany Road City/County: Rockingham County Sampling Date: 03 May, 2016
ApplicanUOwner: NCDOT State: NC Sampling Point: WA-01 up
Investigator(s): R. Lepsic Section, Township, Range:
Landform (hillslope, terrace, etc.): floodplain Local relief (concave, convex, none): concave Slope (%): 1-5
Subregion (LRR or MLRA): LRR P Lat: 36.347938 Long: -79•884.386 Datum: NAD83
Soil Map Unit Name: Codorus NWI classification:
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:
Narrow berm between WA and SD.
HYDROLOGY
Yes No `� Is the Sampled Area
Yes No ✓ within a Wetland? Yes No ✓
Yes No �
Wetland Hydrology Indicators: Secondarv Indicators (minimum of two required)
Primarv Indicators (minimum of one is reauired; check all that applvl _ Surtace Soil Cracks (B6)
Surface Water (A1) _ True Aquatic Plants (B14) _ Sparsely Vegetated Concave Surface (68)
High Water Table (A2) _ Hydrogen Sulfide Odor (C1) _ Drainage Patterns (B10)
Saturation (A3) _ Oxidized Rhizospheres on Living Roots (C3) _ Moss Trim Lines (B16)
Water Marks (B1) _ Presence of Reduced Iron (C4) _ Dry-Season Water Table (C2)
Sediment Deposits (B2) _ Recent Iron Reduction in Tilled Soils (C6) _ Cra�sh Burrows (C8)
Drift Deposits (B3) _ Thin Muck 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 (69) _ Microtopographic Relief (D4)
_ Aquatic Fauna (613) _ FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No ✓ Depth (inches):
Water Table Present? Yes No ✓ Depth (inches):
Saturation Present? Yes No ✓ Depth (inches): Wetland Hydrology Present? Yes No ✓
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
Wetland hydrology indicators not present.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: WA'01 up
Absolute Dominant Indicator pominance Test worksheet:
Tree Stratum (Plot size: 10' x 10' � % Cover Species? Status Number of Dominant Species
�. That Are OBL, FACW, or FAC: 2 (A)
2.
Total Number of Dominant
3. Species Across All Strata: 5 (B)
4.
- Percent of Dominant Species
5• That Are OBL, FACW, or FAC: 40% �p,�g�
6.
7.
8.
Saolinq/Shrub Stratum (Plot size: 10' x 10' �
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 10' x 10' �
�. Rosa multifloria
2. Polystichum acrostichoides
3. Sambucus nigra
4 Phytolacca americana
5. Verbensina alternifolia
6.
7.
8.
9.
10.
11.
12.
Woodv Vine Sfratum (Plot size: 10' x 10' �
� Lonicera japonica
2 Toxicodendron radicans
3 Pueraria montana
4.
5.
6. -
Total % Cover of: Multiplv bv:
�% = Total Cover OBL species � x 1= �
FACW species � x 2 = �
FAC species � x 3 = �
FACU species � x 4 = �
UPL species � x 5 = �
Column Totals: � (A) � (B)
�
�% = Total Cover
Prevalence Index = B/A = �
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
2 - Dominance Test is >50%
3- Prevalence Index is 53.0'
_ 4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
P bl t' H d h t' Ve etafon' (Ex lain)
20 Y FACU - ro ema ic y rop y ic g i p
5 N FACU
15 Y FAC 'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
5 N FACU
Definitions of Four Vegetation Strata:
10 N FAC
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
SaplinglShrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than 3.28 ft(1 m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
55°/a = Total Cover �oody vine - All woody vines greater than 3.28 ft in
height.
30 Y FACU
20 Y FAC
40 Y UPL
Hydrophytic
Vegetation ✓
Present? Yes No
9�% = Total Cover I
Remarks: (Include photo numbers here or on a separate sheet.)
Small narrow sediment deposibberm between WA and SD. Open canopy with no trees. Plot size reduced.
US Army Corps of Engineers Eastern Mountains and Piedmont-Version 2.0

SOIL Sampling Point: WA-01 up
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inchesl Color (moistl % Color (moist) % Tvpe Loc Texture Remarks
0-10 10YR 416 100 sand
10-12+ 10YR 5/3 100 sand
'T e: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Linin , M=Matrix.
Hydric Soil Indicators: Indicators for Problematic Hydric Soils3:
Histosol (A1) _ Dark Surface (S7) _ 2 cm Muck (A10) (MLRA 147)
Histic Epipedon (A2) _ Polyvalue Below Surface (S8) (MLRA 147, 148) -= Coast Prairie Redox (A16)
Black Histic (A3) _ Thin Dark Surface (S9) (MLRA 147, 148) (MLRA 147, 148)
_ Hydrogen Sulfide (A4) = Loamy Gleyed Matrix (F2) = Piedmont Floodplain Soils (F19)
Stratified Layers (A5) Depleted Matrix (F3) (MLRA 136, 147)
2 cm Muck (A10) (LRR N) = Redox Dark SurFace (F6) _ Red Parent Material (TF2)
Depleted Below Dark SurFace (A11) _ Depleted Dark Surface (F7) _ Very Shallow Dark SurFace (TF12)
Thick Dark Surface (Al2) _ Redox Depressions (F8) _ Other (Explain in Remarks)
Sandy Mucky Mineral (S1) (LRR N, _ Iron=Manganese Masses (F12) (LRR N,
MLRA 147, 148) MLRA 136)
Sandy Gleyed Matrix (S4) _ Umbric SurFace (F13) (MLRA 136, 122) 3lndicators of hydrophytic vegetation and
Sandy Redox (S5) _ Piedmont Floodplain Soils (F19) (MLRA 148) wetland hydrology must be present,
Stripped Matrix (S6) unless disturbed or problematic.
Restrictive Layer (if observed):
Type:
Depth (inches): Hydric Soil Present? Yes No ✓
Remarks:
Hydric soil indicators not present
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont
ProjecUSite: Bridge No. 039 on SR 2316 Bethany Road City/County: Rockingham County Sampling Date: 03 May, 2016
Applicant/Owner: NCDOT State: NC Sampling Point: WA-01 wet
Investigator(s): R. Lepsic Section, Township, Range:
Landform (hillslope, terrace, etc.): seep Local relief (concave, convex, none): �ncave Slope (%): �'5
Subregion (LRR or MLRA): LRR P Lat: 36.347938 Long: -�9.884386 - Datum: NAD83
Soil Map Unit Name: Cordorus NWI classification: PSS1
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.)
SUMIVIARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes � No Is the Sampled Area
Hydric Soil Present? Yes ✓ No within a Wetland? Yes ✓ No -
Wetland Hydrology Present? Yes � No .
Remarks:
Small hillside seep draining into SD.
HYDROLOGY"
Wetland Hydrology Indicators: Secondarv Indicators (minimum of two reauired)
Primarv Indicators (minimum of one is reauired; check all that aaolvl = Surface Soil Cracks (66)
✓ Surface Water (A1) _ True Aquatic Plants (B14) . = Sparsely Vegetated Concave,Surface (B8)
✓ High Water Table (A2) ✓ Hydrogen Sulfide Odor (C1) _ Drainage Patterns (B10)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) _ Moss Trim Lines (B16)
Water Marks (B1) _ Presence of Reduced Iron (C4) � Dry-Season Water Table (C2)
Sediment Deposits (B2) Recent Iron Reduction in Tilled Soils (C6) _ Crayfish Burrows (C8),
Drift Deposits (B3) _ Thin Muck Surface (C7) Saturation Visible on Aerial Imagery (C9)
Algal Mat or Crust (64) _ 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 ✓ No Depth (inches): <1 -
Water Table Present? Yes ✓ No Depth (inches): � �
Saturation Present? Yes ✓ No Depth (inches): �. Wetland Hydrology Present? Yes. ✓ No
includes ca illa frin e '
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks: .
Standing water throughout wetland.
US Army Corps of Engineers Eastem Mountains and Piedmont — Version 2.0

VEGETATION (Four �trata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 5' x 20' � , % Cover Species? Status
1. •
2.-
3.
4.
5:
6.
7.-
8.
�% = Total Cover
Saolina/Shrub Stratum (Plot size: 5' x 20' �
�. "Sambucus nigra � � 15
2. Lindera benzoin 10
3 -Fraxinus profunda 10
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 5' x 20' �
q. Rosa multifloria
2. Rubus argutus
g. Eutrochium purpureum
4. -
5.
6.
�,,
8. �
9.
10.
11. -
12.
Woodv Vine Stratum (Plot size: 5' x 20' �
�. Lonicerajaponica
2. Toxicodendron radicans
3. Pueraria montana
4.
5:
6.
Y
Y
Y
35% = Total Cover
Sampling Point: WA-01 wet
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 5 (A)
Total Number of Dominant
Species Across All Strata: S (B)
Percent of Dominant Species
Tliat Are OBL, FACW, or FAC: 62.5% �q�g�
Total % Cover of: Multiolv bv:
OBL species � x 1 = �
FACW species � x 2 = �
FAC FAC species � x 3= �
FAC FACU species � x 4= �
OBL UPL species � x 5= �
Column Totals: � (A) � (B)
10 Y FACU
5 Y FACU
5 . Y FAC
Prevalence Index = B/A = �
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
✓ 2 - Dominance Test is >50%
3- Prevalence Index is 53.0'
_ 4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetation' (Explain)
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Vegetation Strata:
� Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.--
Sapling/Shrub - Woody plants, excluding vines, less =
than 3 in. DBH and greater than 3.28 ft(1 m) tall.
Herb-All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
20% = Total Cover Woody vine - All woody vines greater than 3.28 ft in
height.
10 N FACU
40 Y FAC
30 Y UPL
- a0% = Total Cover
2emarks: (Include photo numbers here or on a separate sheet.)
No canopy. Small seep. Plot area reduces to incorporate wetland area.
Hydrophytic
Vegetation
Present? Yes ✓ No
US Army Corps of Engineers Eastern Mountains and Piedmont -Version 2.0

SOIL Sampling Point: WA"01 wet
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix Redox Features
(inchesl Color (moistl % Color (moist) % Tvae Loc Tezture Remarks
0-2 7.5YR 4/2 100 . loamy sand
2-12+ 10YR 4/2 . 90 10YR 5/1 10 D M loamy sand
�
'T e: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Fore Linin , M=Matrix.
Hydric Soil Iridicators: ' Indicators for Problematic Hydric Soils3:
Histosol (A1) _ Dark Surface (S7) _ 2 cm Muck (A10) (MLRA 147)
Histic Epipedon (A2) = Polyvalue Below Surface (S8) (MLRA 147, 148) _ Coast Prairie Redox (A16)
Black Histic (A3) Thin Dark Surface (S9) (MLRA 147, 148) - (MLRA 147, 148)
_ Hydrogen Sulfide (A4) = Loamy Gleyed Matrix (F2) _ Piedmont Floodplain Soils (F19)
Stratified Layers (A5) _ Depleted Matrix (F3) � (MLRA 136, 147)
2 cm Muck (A10) (LRR N) = Redox Dark Surface (F6) _ Red Parent Material (TF2)
Depleted Below Dark Surface (A11) _ Depleted Dark Surface (F7) _ Very Shallow Dark Surface (TF12)
Thick Dark SurFace (Al2) _ Redox Depressions (F8) _ Other (Explain in Remarks)
Sandy Mucky Mineral (S1) (LRR N, _ Iron-Manganese Masses (F12) (LRR N,
MLRA 147, 148) MLRA 136)
Sandy Gleyed Matrix (S4) _ Umbric Surface (F13) (MLRA 136, 122) 3lndicators of hydrophytic vegetation and
Sandy Redox (S5) _ _ Piedmont Floodplain Soils (F19) (MLRA 148) wetland hydrology must be present,
✓ Stripped Matrix (S6) unless disturbed or problematic.
Restrictive Layer (if observed)c �
TyPe:
Depth (inches): Hydric Soil Present? Yes ✓ No
Remarks: '
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

�/�
i�6'ETI�AI�T� �A'I'ING WORKS�EE'T Fo�arth Versaon
ProjectName L�r�:�,�� �� a,,<,• �J�:��{, ���,..� NearestRoad �.,���,,,, �� v/� ��!�
County %?o�. �, �,�, �,� �,, Wetland area •�o �, / acres Wetland width � /o ' feet
Name of evaluator /�. � �
Wetiand loca�ion
_ on pond or lake
� on perennial siream
_ on intermittent stream
within interstream divide
other:
Soil series: _ �a�„��,,,�
_ predominantly organic - humus, muck, or
peat
_ predominantly mineral- non=sandy
� predominantly sandy
Hydraulic factors
� steep topography
ditched or channelized
total wetland width > 100 feet
Wetland type (seflect one)�`
Bottomland hardwood forest
Headwater forest
Swamp forest
Wet flat
Pocosin
_ Bog forest
Date 3
Adjacent iand use
(within'/z mile upstream, upslope, or radius)
� forested/natural vegetation 9a %
� agriculture, urban/suburban �%
� impervious surface � %
Doanin�nt ve�eiation
(+) 4Y•4�^i.�t-4.�i'.^.Gi v��i�I�Gc:, ��
(2) 7�'vs r� ,�. • -a:. �= f.. �,
(3) � ,-..�.��,-::>.� �-� � � ; s� ,
v
Floodfng and vaetness
� semipermanenily to permanently flooded or
inundated
seasonally flooded or inundated
_ intermittently flooded or temporary surface water
_ no evidence of flooding or surface water
Pinesavanna
Freshwater marsh
_ Bog/fen
_ Ephemeral wetland
_ Carolina bay
� Other: .5�� .
' The rating system cannot be applied to salt or brackisl� marshes or stream channels
1� Water storage ( x 4.00 =�
A Bank/Shoreline stabilization �'? x 4.00 =� �etland
rating
T Pollutant removal � k� x 5.00 = �
I Wildlife habitat / x 2.00 = 0
��
N Aquatic life value ! x 4.00 = 0
G Recreation/Educarion � x 1.00 = 0
** Add 1 point if in sensitive watershed and >10% nonpoint source disturbance within'/z mile upstream, upslope, or radius

S�{
PVC Division of VOlater i�uality -Methoclology for Bcientification of Intermittent and
Peo�ennial Streaov�s and Their Oriains v. 4.11
NC D�VQ Stream Identification Form Version 4.11
Date: �. � 1 Project/Sit�e,�.'�a�� 3 ���e,`' �'
Evaluator: ��� � County: � � , �
'' �` ' R�r Oc. I� G tn-.
Total Points: `� Stream Determination (circle one)
Stream is at least infermittent I yr Ephemeral Iq��Pmitten_ erennial
if a 99 or Aerennial if 2 30* rA r� �.�
Latitude: �, 3�� � �
Longitude:,�� ���Q�
Other �'/�;��s,,
e.g. Quad Name:
A. Geomor holo (Subtotal = /�, ) Absent Weak iilloderate Strong
1B' Continuity of channel bed and bank 0 1 G7`� 3
2. Sinuosity of channel along thalweg 0 1 �1� 3
3. In-channel structure: ex. rifFle-pool, step-pool, 0 1 �j 3
ri le- ool se uence
4. Particle size of stream substrate 0 1 3
5. Active/relict floodplain 0 1 2 ��
6. Depositional bars or benches � 1 2 3
7. Recent alluvial deposits � 1 2 3
8. Headcuts � 1 2 3
9. Grade control CU'? 0.5 1 1.5
10. Natural valley 0 0.5 �.1. 1.5
11. Second or greater order channel � o_=,_Q.. Yes = 3
e --���-�-� -�•1-�-- --- -• --�- � -- - -��-- • • -�
o,.,,,.,,a, ,.,,..,,.,� a,� ,�.,, ,o,�,., .��,. ,.,,,,,.,.�,�,�, ��� ,�,o�,,.a,
B. Hydrology (Subtotal = 7. �S^ )
12. Presence of Baseflow
13. Iron oxidizing bacteria
14. Leaf litter
15. Sediment on plants or debris
16. Organic debris lines or piles
17. Soil-based evidence of high water table?
;�7
1.5
0
0
1
1
Q_�
0.5
0.5
2 C3_
2 3
0.5 0
_..1 1.5
1 �,"Ic5
Yes=3
C. Biolo Subtotal = )
98. Fibrous roots in streambed �'3^'�! 2 1 0
19. Rooted upland plants in streambed �.� 2 1 0
20. Macrobenthos (note diversity and abundance) ""�"y� ,� 0 1 2 �..,_ ,...
21. Aquatic Mollusks �'`s 1 2 3
22. Fish � 0.5 1 1.5
23. Cra�sh G� 0.5 1 1.5
24. Amphibians �� 0.5 1 1.5
25. Algae �.� 0.5 1 1.5
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 Of,�e_r =„
`perennial streams may also be identified using other methods. See p. 35 of manual.
� �
Notes: ��• :- ,=.,�, re < <'v� .o- ..._�c . ��� T �v..ib v/^` t �,� ' ,.r.' � �
,...; � � � r �..- �,,..�� �� s t 6 k ��a
,�,
Sketch: --- �
s'2)3 �
.-�_ .__._
,��/tiY�_.�1
- IS�'J 5� �� N` Ll.�. 1<�r! i
�� = `=� �-.-� - �" % `, � d
� - �- - -- \�t �,;�� K��lz�
V�• . J'�`'___R "�'� �'�
4�

. LJSACF, AID#___ ___.__ ____ __-____ (��'Q f�__ _.---_ �._.-�--___ Site �___- {indicate on attached map) I
---_ ____ . - -
._—�_ _ . _ _ }^
._ :�� � �
;,� STREAM QUALITY ASSESSMENT W4RKSHEET
Provide the following information for the stream reach under assessment: "''
l. Applicant's name: /yG'�o % 2. Evaluator's name: �� �g:>�r�
3. Date of evaluation: S 3� 4. Time of evaluation: �' :�-.'.� :"
S. Name of stream: GJT /i• s,�,a e`� � J!' 6. River basin: �o�; t��ol5 G [>�,;:,K•✓ �c r, �� o: � F`�?
4
7. Approximate drainage arca: ^' ��6 r� 8. Stream order: �
9. Length of reach evaluated: >D ' 10. County: K v�/c,' h-1 � y.�
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):�
Latitude (ex. 34.872312): �. 3�� 7 / g Longitude (ex. —77.556611): ' 7 �'I- �8`iG��. �
Method location determined (circle): GPS Topo Sheet Ortho (Aeria �o/GIS. Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
14. Proposed channel work (if any): L:
15. Recent weather conditions: .��� �
16. Site condirions at time of visit:
�' i b" c.A7 1 I�
17. Identify any special watenvay classifications known�, _Section 10 _Tidal Waters _Essential Fisheries Habitat
__�,_Trout Waters �Outstanding Resource Waters _ Nutrient Sensitive Waters _Water Supply Watershed (1-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? YES� 20. Does channel appear on USDA Soil Survey? YES'� O
21. Estimated watershed land use: _% Residential _% Commercial ____% Industrial � 5% Agricultural
��% Forested 3'� % Cleared / Logged _% Other (
22. Bankfull width: �-� � 23. Bank height (from bed to top of bank): ���
24. Channel slope down center of strcam: _Flat (0 to 2%) XGentle (2 to 4%) _Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: �Straight _Occasional bends _Frequent meander _Very sinuous _Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., t6e stream flows from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Evaluator's Signature � Date � /,) �(o
This channei evaluation form is i ended to be used only as a guide to assist landowners and envi onmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change version 06/03. To Comment, please call 919-876-8441 x 26.

�1�� �
�Y',�...� i.� r
c
STREAIVI QUALITY ASSESSMENT WORKSHEET "
ECOR�GrON POi�TT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
� Presence of flow / persistent pools in stream 0- 5 0- 4 0- 5 �
no flow or saturation = 0- stron flow = max ints
2 Evidence of past human alteration 0- 6 0- 5 0- 5
extensive alteration = Q� no alteration = max oints � 1�7�
Riparian zone 3 .-.:.� ' ��
3 no buffer = 0; conti ous, wide buffer = max oints 0- 6 0- 4 0- 5 �',,✓� •!�`s
4 Evidence of nutrient or chemical discharges 0- 5 0- 4 0- 4 L�!
extensive dischar es = 0; no dischar es = max oints
�5 Groundwater discharge 0- 3 0- 4 0- 4 �
� no disch e= 0; s rin s see s, wetlands, etc. = max oints
,.,., Presence of adjacent floodplain �
� 6 0-4 a-4 0-2
no flood lain = 0; extensive flood lain = max oints
� Entrenchment / floodplain access 0- 5 0- 4 0- 2 y
�"' dee 1 entrenched = 0: fr uent floodin = max oints
g Presence of adjacent wetlands 0- 6 0- 4 0- 2
no wetlands = 0• lar e ad'acent wetlands = m� oints �
9 Channel sinuosity 0- 5 0- 4 0- 3
extensive channelization = 0: natural meander = mas ints
� Q Sediment input 0- 5 0- 4 0- 4 ��
extensive d osition= 0• little or no sediment = max oints
11 Size & diversity of channel bed sabstrate N�4* 0- 4 0- 5 L�
fine homo enous = 0• laz e, diverse sizes = ma�c oints
12 Evidence of channel incision or widening 0- 5 U- 4 0- 5 �i
,�.� dee 1� incised = 0• stable bed & banks = max oints
� 13 1'resence of major bank failures 0- 5 0- 5 0- 5 ^
� severe erosion = 0; no erosion stable banks = max ints �
� 14 Root depth and density on banks 0- 3 0- 4 0- 5
E., no visible roots = 0; dense roots throu out = max ints
� Impact by agriculture, livestock, or timber production `/
15 substanrial im act �; no evidence = max oints 0- 5 0- 4 0- 5 -7
16 1'resence of riffle-pooUripple-pool complexes 0- 3 0- 5 0- 6 y d�
� no riffles/ri les or ools = 0� well-develo ed = ma�c oints
� 17 Habitat co�nplexity 0- 6 0- 6 0- 6 > "��
little or no habitat = 0; uent, varied habitats = max oints `� "" i'�
�� 8 Canopy coverage over streambed 0- 5 0- 5 0- 5 3"�""
� no shadin ve etation = 0• continuous cano = max oints ��•
� 9 Substrate embeddedness �;A* 0- 4 0-� �- f
dee 1 embedded = O; loose struchzre = ma�c
Presence of stream invertebrates (see page 4) "^��
20 no evidence = 0• common numerous es = ma�t oints 0- 4 0- 5 0- 5 �� �,,,ol , s
� Presence of amphibians
O 2� no evidence = 0; common numerous es = max oints 0- 4 0- 4 0- 4 �
O 22 Presence of fish 0- 4 0- 4 0- 4
� no evidence = 0� commo numerous es = max oints �
Evidence of wildlife nse 1��,�,� �,/
23 no evidence = 0� abundant evidence = ma�c oints 0- 6 0- 5 0- 5 `�_
•�.,�
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) ��/
" These characteristics are not assessed in coastal streams.

NC DivBsion of I�P�ter Quality -IiAethodoiogy for ldentification of InYertnitten� and
Perenraial Streams arad Their �rigins v. 4.11 �/�
NC D�VQ Stream Identificat�on Forin Version 4.11
Date: Project/Site: �r� '�` � s b� � Latitude: Z ►
3/�6 ��2 3�G 3.���,�,. r..� 3�. :., y7 c� �.
Evaluator: �, County: ;� Longitude:_ �
� �:'� 1C o�.�� r':. �+z. i�,�� `/�'o
'Potal PointS: Stream Determination (circle e) Other /� I%5�,,,,-D
Stream is st least intermittent ���. Ephemeral Intermlttent nnia e.g. Quad Name:
if z 19 or nerennial if >_ 30* r-. _
A. Geomor holo Subtotal = l�s' " Absent 1Meak
18' Continuity of channel bed and bank 0 1
2. Sinuosity of channel along thalweg 0 1
3. In-channel structure: ex. riffle-pool, step-pool, p 1
ri le- ool se uence
4. Particle size of stream substrate 0 1
5. Active/relict flaodplain ,c rfm ...., � �
6. Depositional bars or benches 0 �
7. Recent alluvial deposits 0
8. Headcuts 0 1
9. Grade control x,, .,� ,�,�,)� 3,�,�s 0 0.5
10. Natural valley 0 0:5
11. Second or greater order channel =
artificial ditches are not rated; see discussions in manual
B. H drolo Subtotal = �
12. Presence of Baseflow 0 1
13. Iron oxidizing bacteria �..� 1
14. Leaf litter �,5•�' 1
15. Sediment on plants or debris ��' 0.5
16. Organic debris.lines or piles 0 0.5
17. Soil-based evidence of high watertable? �..=.,0,,..
C. Biolo Subtotal = 1
98. Fibrous roots in streambed :�':'� 2
19. Rooted upland plants in �treambed ��'= 2
20. Macrobenthos (note diversity and abundance) '„'"Y �` � Y 0 1
21. Aquatic Mollusks c� 1
22. Fish �'=' 0.5
23. Crayfish �'' 0.5
24. Amphibians �h 0.5
25. Algae � �.5
26. Wetland plants in streambed FACW = 0.
'perennial streams may also be identified using other methods. See p. 35 of manual.
NOt2S:
5ketch:
�.:=�--� +��1� ��
' sa ~,-.�
�. -�:�: �---„ � ,- K��z �
� `�,..
s�
41
Mod�rate
2
2
Q�
�
2
. 2
2
3
3
3
3
3
�) 1.5
1 �5__
Yes = 3
2 G�;,`•
2 3
0.5 0
1 1.5
1 5
Yes = 3
0
0
3 ,
1.5
1.5
1.5
1.5

I;SAc"t�. Alf)n
s� -- - _.._ _f
DWQ # Site # (indicate on attached map)
���u STREAM QUALITY A5SESSMENT WORKSHEET � x� � �;. f�,
; ,��'
Provide t6e following information for the stream reach under assessment: ��-
1. Applicant's name: /%�G��7
3. Uate of evaluation: ����<<G
5. Name ofstream: C_%% '7t, f�.::,,:-,.� � ��,d�
7. Approximate drainage area: ^' 3 s�, r�, 5
9. Length of reach evaluated: �c� �
11. Site coordinates (if known): prefer in decimal degrees.
�
2. Evaluator's na�ne: f5 • `- � _
� ='------
4. Time of evaluation: ���' i�
6. River basin: /�o ��k� J'r:�{ �<� !''�,���/��
t
8. Stream order:_ �
10. County: �a�k�'��+r�.�,
v �
12. Subdivision name (if any):�/y�
Latitude (ex. 34.872312): �,. 3� 7� � Longltude (ex. -77.556611): - 7�i. �� `+�'�0 3
Method location determined (circle): GPS Topo Sheet Ortho (Aer:t�IZPhot�^- o� � Other GIS 01her
13. Location of reach under evaluation (note nearby roads and landmarks and attach map i^d�entifying stream{s) location):
�.�?i�r r .i !!l.'�� d�tt ✓ /�� .�_<� ��'f� L... /t �d / l + v ..t6.'7 SUS ICFG fi sx�+ ' n �. :,'•qc.F':a 4,
14. Proposed channel work (if
15. Recent weather conditions:
;n�f. �
�i�
^ � � �-_
16. Site conditions at time of visit: � rfil+� ��,, wr,� `+.. •�'-'� i�
17. Identify any special waterway classifications knownC, _Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters _ Nutrient Sensirive Waters _Water Supply Watershed (I-I�
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? YES� 20. Does channel appear on USDA Soil Survey? YES�1tQ�
21. Estimated watershed land use: _% Residential
�o% Forested
22. Bankfull width; o�� 3�
_% Commercial _Y_% Industrial �% Agricultural
�d % Cleared / Logged �% Other ( )
23. Bank height (from bed to top of bank): �- 3`
24. Channel slope down center of stream: _Flat (0 to 2%) _Gentle (2 to 4%) �Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: Shaight _Occasional bends x Frequent meander _Very sinuous _Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic rnust be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a farest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Evaluator's Signature 1 �-- Date S�/��/G
This channel evaluation form is i ended 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 dces not imply a
particular mitigation ratio or reqairement. Form subject to change version 06/03. To Comment, please call 919-876-8441 x 26.

�t: �� G � 3 I
STREAM QUALITY ASSESSMENT WORKSHEET
�ji
EC�REGION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
� Presence of flow / persistent pools in stream 0— 5 0— 4 0— 5 �
no flow or saturation = 0; stron flo�v = max oints
2 Evidence of past human alteration 0— 6 �— 5 0— 5 �
e�ctensive alteration = 0; no alteration = ma�c oints
Riparian zone w��4
3 0— 6 0— 4 0— 5 ��c,,f :,, f;,,,�
no buffer = 0• conti ous wide buffer = max ints f��,�.,.
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 �-/
extensive dischar es = 0• no dischar es = mau oints
�5 Groundwater discharge 0— 3 0— 4 0— 4 �
U no dischar e= 0• s rin s, se s wetlands. etc. = max oints
� 6 Presence of adjacent floodplain 0— 4 0— 4 0— 2 a"`.�"' �
no floo lain = 0� extensive flood lain = max oints
� � Entrenchment / floodplaia access 0— 5 0— 4 0— 2 3 �
dee 1 entrenched = 0� fr uent floodin = max oints �'"<�';" .
g Presence of adjacent wetlands 0— 6 0— 4 0— 2 I
no wetlands = O; lar e ad'acent wetlands = ma�: oints �
9 Channel sinuosity 0— 5 0— 4 0— 3 '"'{"'�`"f
extensive channelization = 0; natura] meander = max oints `;
1
Sediment input �'w��.� �''3�
10 extensive de osirion= 0; little or no sediment = ma�c �� 0— 5 0— 4 0— 4 a, `; ;.. `•1.�"
11 Size & diversity of channel bed snbstrate NA* 0— 4 0— 5 �
fine, homo enous = 0; lar e, diverse sizes = maac oints
Evideoce of channel incision or widening a r
�. � z dee 1 incised = 0; stable bed & banks = ma�c oints 0— 5 0— 4 0— 5 � ��•'
"" 13 Yresence of major baok failures 0— 5 ' 0— 5 0— 5 j`�"` .
� severe erosion = 0; no erosion stable banks = max ints
� � 4 Root depth and density on banks 0— 3 0— 4 0— 5 „)
no visible roots = 0; dense roots throu out = ma� ints
� Impact by agriculture, livestock, or timber production N
� 5 substantial im act �• no evidence = m� oints 0— 5 0— 4 0— 5 �
16 Presence of rifIle-pooUripple-pool com plexes 0— 3 0— S 0— 6 j�`�1y
� no riffles/ri les or ols = 0� well-develo ed = maac ints �
Q 1 � Habitat compleaity 0— 6 0— 6 0— 6 �
� little or no habitat = 0• fre uent varied habitats = max oints
�18 Canopy coverage over streambed U— 5 0— 5 0— 5 ?
,S no shadin ve etation = 0• continuous cano = max oints �% r:.,.�:�y
19 Substrate embeddedness NA* 0— 4 0— 4 �
dee 1 embedded = 0• loose structure = max �
Z� Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Z n'���� ��/�f �
�„� no evidence = 0• common nuinerous es = max oints � 4�� s��
(7 Z1 Preseoce of amphibians 0— 4 0— 4 0— 4 /�r� g
O no evidence = 0; common, numerous es = max oints �
0 22 Presence of fis6 0— 4 0— 4 0— 4 �
� no evidence = 0; common, numerous es = ma�: oints
23 Evidence of wildlife use 0— 6 0— 5 0— 5 �`, ,.� .,.,�, I_
no evidence = 0; abundant evidence = ma�c oints
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) (p �
'" These characteristics are not assessed in coastal streams.

S� �<o �5 C��� /�
NC Diviseon of �9/ater Quali�y -Methodology for ldentifBcatior� of intermittent and �� -����'s �
Perennial Streams and 'fheir Origins v. 4.11
N� I)WQ Strea� Identifica�aoaa Form Version 4.Y1
Date: ProjectlSite°a d c 35 dh ��y� „3
3 /� .�� 3� �T� �Y ; Latitude: ,� �
Evaluator: `` �, County: �"� �, 1 Longitude:
., , � , �..�� ��., . 7�. �Sy�a �
TOt�I Points: Stream Deterrni ation (circie one) Other Fl�;sde �^o
5tream is at leasf intermittent 3 c�' � Ephemeral In4ermittent erenn e,g. Quad Neme:
if z 19 or nerennia/ if z 30•
A. Geomor holo (Subtotal =�� •�) Absent !�leak R�oderate 5trong
18� Continuity of channel bed and bank 0 1 2' ��•
2. Sinuosity of channel along thalweg 0 1 2 '�m -�
3. In-channel structure: ex. riffle-pool, step-ponl, 0 1 2 �' 3'. %
ri I� ool se uence �-•
4: Particle size of stream substrate 0 1 2 �:.. ;,.'•
5. Active/relict fioodplain ��or,,,,,� 0 2 3
6. Depositional bars or benches �„ ,.{,.,, • F,, 0 1 � 2 ,�3_� __
7. Recent alluvial deposits 0 �3� 2 3
8. Headcuts �� 1 2 3
9. Grade control 0 0.5 " �� 1.5
10. Natural'valley 0 0.5 1 �.a�
11. Second or greater order channel No = 0 ' es = 3
B. H drolo Subtotal =
12. Presence of Baseflow
13. Iron oxidizing bacteria
14. Leaf litter
15. Sediment on plants or debris
16. Organic debris_ lines or piles
17. Soil-based evidence of high water table?
C. Biolo Subtotal = .
18. Fibrous roots in strearnbed
19. Rooted upland plants in streamtied
20. hAacrobenthos (note diversity and abundance)
21. Aquatic Mollusks
22. Fish
23. Crayfish
24. Amphibians
25. Algae
26. Wetland plants in streambed
*perennial sVeams may also be identified using other methods. See
SketCh: t��'�_ �•��>y`�
`
/
3G '"s�_ ..
�
n
C�:
3 y�
�?s 3
41
�
�
1
1
0.5
0.5
2 c�.
2 3
0.� 0
1 1.5
1 ,,..a�..,�v
Yes=3
2 1
2 1
1 2
1 2
0.5 1
0.5 1
0.5 1
0.5 1
FACW = 0.75; OBL = 1.5
�
0
0
3
3
1.5
1'.5
1.5 '
1.5
��

_.__. -------_. ---- _____ ____ ______ __ ._r__ _
_ _ . _ _ __ _.
� USACF AIll#�� ___�__ I)VVQ # Site #_� (indicate on attached map} I
- - - - __ i c_` / -
(�` STREAM QUALITY ASSESSMENT WORKSHEET
�� .__.�
.
,��'
Provide the following information for the stream reach under assessment:
l. Applicant's name: /(�� �-'�"T^ 2. Evaluator's name: �• ��v.��' ,'i
3. Date of evaluation: S�z �/( 4. Time of evaluation: „� :Qt..) �/'f
!�—, �
�
5. Name of stream: �.��:.�s �✓�s � ` L 6. River basin: r'��au ••��'� '....:_✓ �� �����' �� 2-
�.f , .
7. Approximate drainage area: �'�•D ������ ��.-�' �S 8. Stream order: 3
9. Length of reach evaluated: �� ' 10. County: %� �.���' '
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): /�'
Latitude (ex 34.872312): �. �':� �� 3 d Longitude (ex. -77.556611): - 7S. �.*`''," '`^� � �
Method location determined (circle): GPS Topo Sheet Ortho (Aeriaij'�hoto� G> Other GIS Other
13. Lo ation of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
^� ; ` ` f/�/ � //t }I_
LK f r ' BoG InGL ✓, '/'� 4 �'<-�•'L.- / '•`t2k.G � �/�� � tJa.�G/G /� UG s2 s�s (�"r.t•�,���0 h
14. Proposed channel work (if any): �r�c«. '�c.�s�� s�-.�.-� _
15. Recent weather conditions: �� � a�,' � �� -.� � �2c: � �;: <. � `�� .'r'oa'�f 5
16. Site conditions at time of v
/ �
e v
l7. Identify any special waterway classifications known: _Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waiers _Outstanding Resource Waters C_ Nutrient Sensitive Waters _Water Supply Watershed (I-IV)
18. Is there a pond or lake located upstream of the evaluation point?�� N� If yes, estimate the water surface area: ✓ 5 s.�
19. Does channel appear on USGS quad map?� NO
2l. Estimated watershed land use
22. Bankfull width: `��" `'��
� `� % Residential
�% Foresied
20. Does channel appear on USDA Soil Survey? �NO
_% Commercial _% Industrial � c� % Agricultural
%O% Cleared / Logged _% Other (
23. Bank height (from bed to top of bank): �' '�% �
24. Channel slope down center of stream: Flat (0 to 2%) X Gentle (2 to 4%) ,Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: Straight �,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 raage shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. if a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Evaluator's Signature /r.J � „%'- -- Date �/�d /��i
This channel evaluation form is in�%nded to be used only as a guide to assist landowners and onmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change - version 06103. To Comment, please call 919-876-8441 x 26.

��
STREAiVI QUALITY ASSESSMENT WORKS � ET
ECOREGIU V YGIiVT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
1 Presence of flow / persistent pools in stream 0— 5 0— 4 0— 5 �
no flow or saturarion = 0� stron flow = max ints
2 Evidence of past human alteration Q_ 6 0— 5 0— 5 „�j r�1� �
e�ctensive alteration = 0• no alteration = maat oints ��o �� �%�
Riparian zone � �f.� �-.
3 no buffer = 0; conti uous wide buffer = max ints 0— 6 0— 4 0— 5 ��,��
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 �
extensive dischar es — 0; no dischar es = max oints
� 5 Groundwster discharge 0— 3 0— 4 0— 4 �
no dischar e= 0; s rin s, see s, wetlands etc. = max oints
� Presence of adjacent f]oodplain ,,
� 6 0-4 0-4 0—.. ��✓�o �
yr no flood (ain = 0; eactensive flood lain = ma�c oints
� � Entrenchment / floodplain access 0— 5 0— 4 0— 2 �'"•'"
dee 1 entrenched = 0• fre uent floodin = max oints
g Presence of adjacent wetlands 0— 6 0— 4 0— 2
❑o wetlands = 0; lar e ad'acent wetlands = ma�c ints d
9 Channel sinuosity 0— 5 a— 4 0— 3 r�
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 "� �{`
extensive de sition= 0• little or no sediment = maac ints ������
� 1 Size & diversity of channel bed substrate NA* 0— 4 0— 5
fine, homo enous = 0; lar e, diverse sizes = max ints
� 2 Evidence of channel incision or widening 0— S 0— 4 0— 5 � 5� `
,7+ (dee 1 incised = 0• stable bed & banks = max ints �"'''' �
�; Presence of major bank failures 4 +�e%
�.� 13 severe erosion = 0• no erosion stable banks = max oints 0— 5 0— 5 0— 5 � �� `� �
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 �
�; no visible roois = 0; dense roots throu hout = m� oints
� Impact by agriculture, tivestock, or timber production
� 5 substantial im act =0• no evidence = maac ints 0— 5 �— 4 0— 5
16 presence of riffle-pool/ripple-pool complexes 0— 3 0— 5 0— 6
no riffles/ri les or ]s = 0• well-develo ed = max oints `J
� 17 Habitat complexity 0— 6 0— 6 0— 6 �
little or no habitat = 0; fre uent, varied habitats = ma�c oints
�Ca�opy coverage over streambed �-�-�� ��h^�
18 no shadin ve etation = 0• conrinuous cano = max oints 0— 5 0— 5 0— 5 ,3 ,�, ��r,;
� 9 Substrate embeddedness NA * 0— 4 0— 4
dee 1 embedded = 0; loose structure = maac
Presence of stream invertebrates (see page 4) ! �':
20 0-4 0-5 0-5
� no evidence = 0; common numerous es = max oints G' �B �;�
� 21 Presence of amphibians 0— 4 0— 4 0— 4 /��S S
O no evidence = 0• common numerous es = znax oints
'"� Presence of iish
� 22 0-4 0-4 0-4
� no evidence = 0� common numerous es — m� oints �
Evidence of wildlife use � � �.:•.,
23 no evidence = 0; abundant evidence = ma�c ints 0— 6 0— 5 0— 5
,.�.�, n 1
Total Points Possible 100 100 100
TOTAL SCORE (also enter on first page) ��
* These characteristics are not assessed in coastal streams. �
��

NC Divi�ion of 1Na#er C�uality -i�ethociology for ldentifcatioro of le�terrnittent and
Perennial Streams an�! Their Origins v. 4.11 S,�
IdTC DVV Stream Iclentification Form Version 4.11 �
Date: Project/Site: ar���` � i� Latitude�/ ?
3' 3 / s . 3 i� �.�� �, �2,�/ .9 `� �� �o
,
Evaluator: n/ County: //� Longitude:_?� �„�3y�
\. G e'�i A� .D .F i .: W�.
Total Points: Stream Detercnination (circle one) Other �l�'sG�rv
Stream is at least intermittent ��� � Ephemeral Intermitte erenn e.g. Quad Name:
if _> 19 or perennial if>_ 30" _
A. Geomor holo (Subtotal =/8. �) Absent �leak Moderate Strong
1a� Continuity of channel bed and bank 0 1, 2 C"�
2. Sinuosity of channel along thalweg 0 1 2
3. In-channel structure: ex. riffle-pool, step-pool, p 1 � 3
ri le- ool se uence
4. Particle size of stream substrate 0 1 2 C3�
5. Active/relict floodplain •,�; +t..,,. 0 2 3
6. Depositional bars or benches w,g 0 1 � 3
7, Recent alluvial deposits c�� 1 2 3
8. Headcuts i✓s,�� � G. 0 1 �� 3
9. Grade control �� 0 0.5 C'.1.._. 1.5
10. Natural valley 0 0.5 - 7 .�.�
11 _ Second or greater order channel �; No = 0� Yes = 3
o„���.,�a� ..,,..,��, a,� ,,,,, ,a,"., J`� ..,�.,,.,�,,,,.� ,,, ,,,�,,,.o,
B. H drolo Subtotal =`� S
12. Presence of Baseflow 0 1 2
13. Iron oxidizing bacteria 1 2
14. Leaflitter r`",;�y...% 1 0.5
15. Sediment on plants or debris �= 0.5 1
16. Organic debris lines or piles �@-�° 0.5 1
17. Soil-based evidence of high water table? _
C. Biolo Subtotal = l
18. Fibrous roots in s4reambed ''3`� 2-- 1
19. Rooted upland plants in streambed _ � 2 1
20. Macrobenthos (note diversity and abundance) r,`�0�° 1 2
21. Aquatic Mollusks .=s'"0'`� 1 2
22. Fish ��.'°'b'`:� 0.5 1
23. Cra�sh �3'' o.5 1
24. Amphibians � 0.5 7
25. Algae c��'� 0.5 1
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 (
*perennial streams may also be identifled using other methods. See p. 35 of martual.
Notes: ��.•�;,,. ..� ,� -�1.� r...� flo,,,.s �` r...�� �:�_!C f�',�1�� .<.4�.,..0_ -���,
Sketch:
�
"q
41
Yes = 3
��
3
0
1.5
1.5
0
0
3
3
1,5
1.5
1.5
1.5

� —___ ._ ._. . _ _. . .. . _ . . .. _
,_i"i
� USACE AIDti_-_ _--- --____—_--_-_.._ D1�JQ # __---�. --__-_--.._ Site #-_ --_. (indicate on attached map) i
�____ _ _- _ ___ _ _
_ _ - - -- __-- -
�r���,� 35
;,o„ STREAM QUALITY ASSESSMENT WORKSHEET ,.,
Provide the following iuformation for the stream reach under assessment:
I. Applicant's name: /11G� ' 2. Evaluator's name: ��s �; r�
3. Date of evaluation: �/3�/� 4. Time of evaluation: a7 .�"� ¢• ��_
5. Name of stream: U'� ��=���• _. ��I�� 6. River basin: ��hois� J,►�,� � L� s� r`'::�/v %� �
t� � .
7. Approximate drainage area: �- �O .ca.�c.5 __ 8. Stream order:
f
9. Length of reach evaluated: /3�' 10. County: ?rx..��'r� �e �r
J
l l. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): �
La[itudc (ex. 34.8123I2): �. � `��� F'o "� Longitude {ea. -77.556611): ` 7`'I. � S `�3 `'�7
Method location determined (circle): GPS Topo 5heet Ortho (Ae oto/Gj Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks,and attach map ident fying stream(s) location):
�% ( NL � v 1� iS..�.a 6�GL ✓' ��'�L ��r'L L�.. /� DCiI� l� f fJ`-�L�f i]c.�.o�G.�L ��.<.r.� • v� �%✓�'�jiG�o h ...-
14. Proposed channel work (if
15. Recent weather
16. Site co��ditions at time of
�
�
�—�,���. �� �
17. ldentify any special waterway classifications known: _Section 10 �Tidal Waters _F.ssential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters C Nutrient Sensirive Waters _Water Supply Watershed (I-1V)
18. Is there a pond or lake located upstreatn of the evaluation point? YES �O If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? YES� 20. Does channel appear on USDA Soil Surveyl YES�
21. Estimated watershed land use: _% Residential _% Commercial _% Industrial /c7 % Agricultural
�% Forested _% Cleared J Logged _% Other ( l
22. Bankfull widtli: /`o� ' 23. Bank height (from bed to top of bank): �� /
24. Channel slope down center of stream: _Flat (0 to 2%) X Gentle (2 to 4%) _Moderate (4 to ]0%) _Steep (>10%)
25. Channel sinuosity: Straight _Occasional bends 1� Frequent meander _Very sinuous _Braided channel
Instructions for completion of works6eet (located oo �age 2): Begin by determining the most appropriate ecoregion based on
location, temain, vegetation, stream classification, ete. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the strearn flows from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. 'The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (fro/m reverse): ��/ Comments: ��'� I��?�� p�� s���� �.,..��� �ru. ��
y1G✓'✓ w 1/ Id6��_ ���,��II v�i�1�i�,.�t c�i�:r..� .�P .vf'!'c�i•r,:. %G.fC i-'...c..tKt.:�/ i�� I�1�.5 c/s+:.. .K.�FI2J i
Evaluator's Signature�� �v�.�1 n� Date S�/d ���
This channel evaluation form is ' tended to be used only as a guide to assist landowners and vine ronmental professionals in
gat6ering t6c data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change - version 06/03. To Comment, please call 919-876-8441 x 26.
l

` JU
`��. � � : �'. f ,.. r
STREAM QLTALITY ASSESSMENT WORKSHEET "
ECOREGION POINT ItANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
� Presence of flow / persistent pools in stream 0- 5 0- 4 0- 5
no flow or saturation = 0; skron flow - max ints
2 Evidence of past humao alteration 0- 6 0- 5 0- 5
extensive alteration = 0; no alteration = m� ints �
3 Riparian zone 0- 6 0- 4 0- 5 �����
no buffer = 0; conti uous wide buffer = ma�c oints J''"r,6'"
4 Evidence of nutrient or chemical discharges 0- 5 0- 4 0- 4 ��
extensive dischar es = 0; no dischar es = ma�c ints
� 5 Groundwater discharge 0- 3 0- 4 0- 4 ?�
� no disch e= 0; s rin s see s wetlands, etc. = max oints
� 6 Presence of adjacent floodplain 0- 4 0- 4 0- 2 a"`""
�no flood lain = 0� eatensive flood lain = max oints
� Entrenchment / floodplain access 0- 5 0-� 0- 2 3
p"' dee l entrenched = 0� fre uent floodin = ma�c oints
g Presence of adjacent wetlaods 0- 6 0- 4 0- 2 l S""��
no wetlands = 0• lar e ad'acent wetlands = max oints ✓� N..+'� .
9 Channel sinuosity 0- 5 0- 4 0- 3 �
extensive channelization = 0• natural meander - max ints
10 Sediment input 0- S 0- 4 0- 4 �
extensive d osition= 0; little or no sediment = maat ints
11 Size & diversity of channet bed substrate NA* 0- 4 0- 5 3
fine, homo enous = 0; lar e diverse sizes = max ints
� 2 Evidence of channel incision or widening Q_ 5 0- 4 0- 5 �"`°'
�''' dee I incised = 0; stable bed & banks = max oints J.�,a.��
,, t',, Presence of major bank failures � J
� 13 severe erosion = 0; no erosion, s t a b le ban ks = max oin t s 0- 5 0- 5 0- 5 - r
� 14 Root depth and density on banks 0- 3 0- 4 0- 5 3
no visible roots = 0; dense roots thro out = max ints
� Impact by agriculture, livestock, or timber production �
15 substantia3 im act =-0; no evidence = max oints 0- 5 0- 4 0- 5
� � 6 Presence of riHle-pooUripple-pool complexes Q_ 3 0- 5 0- 6 �
F no riffles/ri les or ols = 0; well-develo d= max oints
� Habitat complexity� �•
� l� little or no habitat = 0• fr uent, varied habitats = max oints �- 6 0- 6 0- 6 �
� � g Canopy coverage over streambed 0- 5 0- 5 0- 5 ���,��� L
no shadin ve etation = 0• continuous cano = max oints �+N• •
� 9 Substrate embeddedness NA* 0- 4 0- 4 �
de 1 embedded = 0� loose structure = max
20 Presence of stream invertebrates (see page 4) 0-� 0- 5 0- 5 '�
� no evidence = 0• common numerous es = ma�c oints C�'
(,� 21 Presence of amphibians 0- 4 0- 4 0- 4
O no evidence = 0• common numerous es = max oints �
''� Presence of fish �
� 22 no evidence = 0• common numerous es = max oints 0- 4 0- 4 0- 4 `
23 Evidence of wildlife ase 0- 6 0- 5 0- 5 � fi"✓`z ''
no evidence = 0 abundant evidence = max oints ,•�„w- _-• {�
Total Points Possible lU0 100 100
TOTAL SCORE (also enter on first page) ��
* These characteristics are not assessed in coastal streams.

/aRCJ�DIS fornaturaland
built assets
PHOTOGRAPHIC LOG
Client Name: Site Location:
North Carolina Department of Transportation Bridge 039 on SR 2166 (Bethany Road)
Date: � �>��"�,��. ,� + - .. y�-��..: �
05/03/2016 �+�`' ` � � �� i� �
: � � �:
'`'�� ` � "�. r�=��
Photo No. 1 � � � ��,�. � # ��r..
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Description: --_ t., .� : x :, 'f,. _.�,�.�, -�
SA - Pipe at origin
Photo No. 2 Date:
05/03/2016
Description:
SAS - Headcut at origin
� �� `'r� � � � ti
�' `� �: `� ` -<' ��
_,� ' ~�r,
�
r � t �ti�.
Project No.
NC612002.6039
-3•.
4
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� � /�RV�DIS bmltatssetsnd PHOTOGRAPHIC LOG
Client Name: Site Location: Project No.
North Carolina Department of Transportation Bridge 039 on SR 2166 (Bethany Road) NC612002B039
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Client Name:
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Photo No. 7
Description:
WA
PHOTOGRAPHIC LOG
Site Location:
ent of Transportation Bridge 039 on SR 2166 (Bethany Road)
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