05_U5603_USACE_Stream_Forms

USACE Am#
DWQ #_
. STREAM QUALITY �
Prawide the following information far the stream reach u
i. Applicant's name: N� j�T
3. Date of evaluation: �l�f � ��'
5. Name of strearn: SB G �I
7. Approximate drainage area; .�(�� G�-[ n-5
r
4. Length of reach evaluated: ��
11. Site coordinates {if knownj: prefer'rn decimal degrees.
Latitude (ex. 34.872312): � �' � G � G "� �
Methvd location determined (circle�: ,{iP� Topv 5heet Ortho (A
13. Loeation vf reach under e�al�n (oate nearby roads and I�
14. Praposed channel work {if any
l5. Recent weather conditivns: r"�- �� �'' ��'�-+
16. Site conditions at time of �isit: ��- �" ►�-� �, `� C!
] 7. fdentify any special waterway classiftcations
�.Trout Waters ,_Outstanding Resource Waters _
18. Is there a pond or lake located upstream of the e�a{uation p
19. Does channel appear an USGS quad map? � 1'�I�D
21. Estimated watershed land use: ��%01a Residential
�% °/a Forested
22. Bankfull width: L� � a r
24. Channel slope down center of stream: /'� Flat (0 tv 2%) .
25. Channel sinuosity: 5traight ,�Occasional bends .
Instructinns for completion of worksheet (Iocated on psge
location, terrain, �egetation, strearn classification, etc. Every c
to each characteristic within the range shawn for ti�e ecore
characteristics identified in the worksheet. Scares should refl
characieristic cannot be e�aluated due to site or weather conc
comment sectian. Where tliere are vbviaus changes in the cha
intn a forest), the stream may 'be di�icled into smaller reaches tl
reach. The total score assigned to a stream reach must range
highest quality.
Total Score {fram re�erse}: �
E�aluatnr's Signature � "'� � '
This chsnr�e! evstuation orm is inte'nded to be used only ;
gathering the data required by the United States Army
qualiiy. The total seare resniting from the camptetion a
partieular mitigation ratio or re�uiremeet. Farrn subject ta
Site # (indicate nn attached map)
�SESSMENT WQRK5HEET ,� , � �D�
r assessment:
2. Evaluatar's name: �.� C•: �•-^� i F� X � o M�
4. Tirne of ewaluation: � '• `�`�
6. Ri�er basin: NPw � �,rV
S. Stream order: i S�
10. County:_ l_ll�-�= v=1��-�
12. Subdivision name (if any
i.ongitude (ex. -77.55661 I j: '� �• �9 � U�' i� ��
PhotalGIS �ther GI5 Other
irks and attach map identifying stream(s) location}:
� s � t�.� v� av �'
Section 16 _Tidal Waters _Essen#ial Fisheries Nabitat
lutrient Sensitive Waters _Water Supply Watershed (I-IV)
nt? YES � If yes, estimate the water surface area:
20. Dves channel appear on USDA 5aii 5urvey'�S NO
_% Commerciai _% Industrial _°!o Agricultural
_°1a Cleared / Lvgged _% Other {
23. Bank height (from bed to top of bank}; J� Z
(2 to 4%) _Moderate (4 to ! 0%) _5teep (� 1 Q%)
nt meander _Very sinuous _$raided channel
; Segin by determining the most appropriate ecaregican 6ased on
acteristic rnust be scored using the same ecoreginn. Assign points
m. Page 3 pro�ides a brief descrip#ion af how to re�iew the
an o�erall assessment of the stream reach under evaluatian. If a
ans, enter 0 it� the scoring btsx ar�d provide an explanation in the
ter of a stream under review (e.g,, the stream flows from a pasture
dispiay mare continuity, and a separate farm used ta evalaate each
ween 0 and 100, with a seore of ] Ufl representing a stream of the
Date �( � � I%�i
a guide to assist landowners and en ronmental professionals in
orps of Engineers to make s preliminary assessment of stream
this form is s�ubject to USACE approval and does not imply a
iange - �ersivn 06/03. To Comrnent, please call 919-87f,-8441 x 26.

STREAM (�UALITY
# CHARA�TERISTICS
� Presence of flow f persistent pools in stream
no flow ar saturaEion = 0• stran flow = m� oints
2 Evidence of past human alteration
extensive alteration = 0° no alteration = rnax oints
3 Riparian ione
no buffer — b• conti upus wide huffer = ma}c oint�
4 Evidence uf nutrient or chemicai discharges
extensi�e dischar es = 0; no dischar es = maac oint
�5 Groundwater discharge
V na dischar e= D• s rin s, see s wetlands, etc. = max �
� � Presence of adjacent floodplain
�„ no flaod [ain = 4• extensive flood lain = max oint
� T Entrenchmeat I Eloadplain access
dee 1 entrenched = 0• fre uent floodin = ma;c oin
$ Fresence af adjacent wetlands
no wetlands =(1; lar e ad'acent wetlands = max oirr
9 Channel sinuosity
extensive channelir..ation = U; natural rneander = maac c
�Q Sediment input
extensi�e de ositian= 0• little or no sediment = max o
�� Size & dir�ersity of channel bed substrate
fine hnmo enous = D� lar e diverse sizes = max oii
lZ Evidence of channel incision or widening
� dee 1 incised = 4• stable bed & banks = max oinY!
� Presence nf majar bank failures
� 13 severe erosion =�; na eros�on, stable banks = max oi
C� 14 Raa� depth and density pn banks
"� no wisible roots = 0; dense roots throu hout = max oi
N
� �$ Impact by agr'rculture, livestvck, or timber prndac
substantial im act =0• no evidence = max vints
1& Presence af rif#]e-pool/ripple-pool complexes
� no riffleslri les or aols = Q• well-de�elo ed = max c
Q Habitat complexity
� �� little ar no habitai = 0; fre uent, varied habitats = rnax
�18 Canopy cor+erage o�er streamhed
x no shadin ve etation = 0• continuous cano = max �
�� Substr�te embe�dedness
dee 1 embecfcted = 0• lovse strueture = max
z� Presence of stream in�ertebrat�s {see page 4)
�„� no e�idence = 0• common numeraus es = max ai
(� Presence of amphibians
Q zl no evidence = Q, corr�mon numeraus es = rnax i
Presence uP fish
� 22 na e�idenee = 4� commvn numerous es = maac i
�3 Evidence af wildlife use
no e�idence = 0• abundant e�idence = max oints
Total Po'snts Foss'rble
TUTAL SCQ�tE (also eate
* These chaeacteristics are not assessed in coastal streams.
2
WORKSHEET
ECOREGION POINT RANGE
Coastal Piedmont Mountain
(1-5 U-4 0—S
0-6 0-5 U-5
d—b 4-4 i}-5
��� 0-5 4-4 0-4
U-3 6-4 Q-4
nts
0-4 U-4 0-2
[I—S �-4 Q-2
� 0-6 0-4 �-2
1� 0—S 4-4 0-3
1s �-5 4-4 0-4
NA* 4-4 U-5
0-5 U-4 4-5
0—S fl-5 0-5
s
0-3 U-4 D-5
s
}n U-5 0-4 0-5
�ts 0-3 0—S 0—G
0-6 0—b 0-6
nts
rts
0-5 D-5 p—S
NA* 0-4 0-4
0-4 0-5 0-5
s
s
0-4 4-4 0-4
s
0-4 0-4 0-4
0-6 0-5 �—S
I00 lU0 lOD
Qn first page)
SCORE
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