_TIP_U5760_Preliminary_JD_Request_REV_1Aug2016

Jurisdictional Determination Request
�. ,;
.
US Army Gorps
of Engineers.
Wilmingtan Distric[
This form is intended for use by anyone requesting a jurisdictional determination (7D) from the
U. S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
to the appropriate Corps Field Office (or proj ect manager, if known) via mail, electronic mail, or
facsimile. A current list of county assignments by Field Office and project manager can be
f�»ncl �n-lin� at: http://www.saw.usace.arm,y.mil/Missions/Re�,ulatorvPermitPro�ram.aspx, by
telephoning: 910-251-4633, or by contacting any of the field offices listed below:
ASHEVILLE REGULATORY FIELD OFFICE
US Arnry Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Numbex: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Arnry Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Farest, North Carolina 27587
General Number: (919) 554-4$84
FiaxNumbex: [phone]
WASHINGTON REGULATORY FIELD OFFICE
US Ari1ry Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number. [phone]
Fax Numbex: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fi ax Numbex: [phone]
Version: December 2013 Page 1

Jurisdictional Determination Request
1NSTRUCTIONS:
All requestors must complete Parts A, B, C, D, E and F.
NOTE TO CONSLTLTANTS AND AGENCIES: If you are requesting a 7D on behalf of a
paying client or your agency, please note the specific submittal requirements in Part G.
NOTE ON PART D— PROPERTY OWNER AUTHORIZATION: Please be aware that all JD
requests must include the current property owner authorization for the Corps to proceed with the
determination, which may include inspection of the property when necessary. This form must be
signed by the current property owner to be considered a complete request.
NOTE ON PART D- NCDOT REQLTESTS: Property owner authorization/notification for 7D
requests associated with North Carolina Department of Transportation (NCDOT) projects will be
conducted according to the current NCDOT/LJSACE proiocois.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD may not
be valid for the wetland conservation provisions of the Food Security Act of 1985. If you or
your tenant are USDA Program participants, or anticipate participation in USDA programs, you
should also request a certified wetland determination from the local office of the Natural
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Version: December 2013 Page 2

Jurisdictional Determination Request
A. PARCEL INFORMATION
StT'0et AddT'eSS: N/A Linear Transportation Project
Clty, State: Kemersville, North Carolina
COUrity: Forsyth
Lii��iivi�S: See Figure 1: Vicinity Map
Parcel Index Number(s) (PIN): N/A (�inear Transportation Project)
B. REQUESTOR INFORMATION
Name: NCDOT; ATTN: Jeff Hemphill, Natural Environment Section
Malllrig AddT'055: 1598 Mail Service Center; Raleigh, NC 27699-1598
Telephone Number: 9�9-�0�-6�26
Electronic Mail Addressl: �HemPn�ii@rvc�oT.go�
Select one:
� I am the current property owner.
❑ I am an Authorized Agent or Environmental Consultant�
❑ Interested Buyer or Under Contract to Purchase
❑ Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: NCDOT; ATfN: Jeff Hemphill, Natural Environment Section
Malllrig AddT'eSS: 1598 Mail Service Center
Raleigh, NC 27699-1598
Telephone Number: 9�9-�0�-6�26
Electronic Mail Address3: �Hempniii@rvc�or.gov
� Proof of Ownership Attached (e.g. a copy of Deed, County GIS/Parcel/Tax Record data)
' If available
Z Must attach completed Agent Authorization Form
3 If available
Version: December 2013 Page 3

Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION4
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U. S. Army Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on-site investigations
and issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction
under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899.
Property Owner (please print)
Property Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
Date
� I am requesting that the Corps provide a preliminarv 7D for the property identified herein.
This request does include a delineation.
� I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does NOT include a delineation.
� I am requesting that the Corps investigate the property/proj ect area for the presence or
absence of WoUSS and provide an �proved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
� I am requesting that the Corps delineate the boundaries of all WoUS on a property/proj ect
area and provide an �proved 7D (this may or may not include a survey plat).
� I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/proj ect area and provide an approved 7D (may or may not
include a survey plat).
' For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
5 Waters of the United States
Version: December 2013 Page 4

F.
�
Jurisdictional Determination Request
ALL REQUESTS
Map of Property or Proj ect Area (attached). This Map must clearly depict the boundaries
of the area of evaluation.
❑✓ Size of Property or Proj ect Area 674.25 acres
n
G.
I verify that the property (or proj ect) boundaries have recently been surveyed and marked
by a licensed land surveyor OR are otherwise clearly marked or distinguishable.
JD REQUESTS FROM CONSULTANTS OR AGENCIES
(1) Preliminary 7D Requests:
� Completed and signed Preliminarv Jurisdictional Determination Form6.
� Project Coordinates: 36.111732 Latitude -80.106633
Maps (no larger than l 1x17) with Project Boundary Overlay:
0
�
�
�
❑
Longitude
Large and small scale maps that depict, at minimum: streets, intersections, towns
Aerial Photography ofthe project area
USGS Topographic Map
Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
6 See Appendix A of this Form. From Regulatory Guidance Letter No. 08-02, dated June 26, 2008
Version: December 2013 Page 5

Jurisdictional Determination Request
Delineation Information (when applicable)�:
Wetlands:
� Wetland Data Sheets8
❑�
❑
❑✓
Upland Data Sheets
Landscape Photos, if taken
Tributaries:
� USACE Assessment Forms
� Other Assessment Forms
(when appropriate)
Field Sketch overlain on legible Map that includes:
■ All aquatic resources (for sites with multiple resources, label and identify)
■ Locations of wetland data points and/or tributary assessment reaches
■ Locations of photo stations
■ Approximate acreage/linear footage of aquatic resources
(2) Approved 7Ds including Verification of a Delineation:
� Project Coordinates:
Latitude
Maps (no larger than l 1x17) with Project Boundary Overlay:
❑
�
❑
�
�
Longitude
Large and small scale maps that depict, at minimum: streets, intersections, towns
Aerial Photography ofthe project area
USGS Topographic Map
Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan,
previous delineation maps)
' 1987 Manual Regional Supplements and Data forms can be found at:
http://www.usace.armv.mil/Missions/CivilWorks/Re�ulatorvPro�ramandPermits/re� supp.aspx
Wetland and Stream Assessment Methodologies can be found at:
http://portal.ncdenr.org/c/document library/�et file?uuid=76f3c58b-dab8-4960-ba43-45b7faf06f4c&groupld=38364 and,
http://www.saw.usace.armv.mil/Portals/59/docs/regulatory/publicnotices/2013/NCSAM Draft User Manual 130318.pdf
$ Delineation information must include, at minimum, one wetland data sheet for each wetland/community type.
Version: December 2013 Page 6

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

Jurisdictional Determination Request
I. REQUESTS FOR CORPS APPROVAL OF SURVEY PLAT
Prior to final production of a Plat, the Wilmington District recommends that the Land
Surveyor electronically submit a draft of a Survey Plat to the Corps proj ect manager for
review.
Due to storage limitations of our administrative records, the Corps requires that all hard-
copy submittals include at least one ori�inal Plat (to scale) that is no lar�er than 11"x17"
(the use of match lines for larger tracts acceptable). Additional copies of a plat, including
those larger than 11"x17", may also be submitted for Corps signature as needed. The
Corps also accepts electronic submittals of plats, such as those transmitted as a Portable
Document Format (PDF) file. Upon verification, the Corps can electronically sign these
r��ate anr� ratnrn tham via a_mai� tn i1lP YPl117PCil�Y
r.�.�„ �...� ..,��... �...,... ..�. ., ...�... �� �..., ..,.��.,,,��..
(1) PLATS SUBMITTED FOR APPROVAL
�❑
�❑
❑
❑
�
❑�
❑�
�
Must be sealed and signed by a licensed professional land surveyor
Must be to scale (all maps must include both a graphic scale and a verbal scale)
Must be legible
Must include a North Arrow, Scale(s), Title, Property Information
Must include a legible WoUS Delineation Table of distances and bearings/metes
and bounds/GPS coordinates of all surveyed delineation points
Must clearly depict surveyed property or project boundaries
Must clearly identify the known surveyed point(s) used as reference (e.g. property
corner, USGS monument)
When wetlands are depicted:
• Must include acreage (or square footage) of wetland polygons
• Must identify each wetland polygon using an alphanumeric system
Version: December 2013 Page 8

Jurisdictional Determination Request
� When tributaries are depicted:
• Must include either a surveyed, approximate centerline of tributary with
approximate width of tributary OR surveyed Ordinary High Water Marks
(OHWM) of tributary
• Must identify each tributary using an alphanumeric system
• Must include linear footage of tributaries and calculated area (using appro�mate
widths or surveyed OHWM)
• Must include name of tributary (based on the most recent USGS topographic
map) or, when no USGS name exists, identify as "unnamed tributary"
� all depicted WoUS (wetland polygons and tributary lines) must intersect or tie-to
surveyed project/property boundaries
� Must include the location of wetland data points and/or tributary assessment
reacnes
� Must include, label accordingly, and depict acreage of all waters not currently
subject to the requirements of the CWA (e.g. "isolated wetlands", "non-
jurisdictional waters"). NOTE: An approved 7D must be conducted in order to
make an official Corps determination that a particular waterbody or wetland is not
jurisdictional.
� Must include and survey all existing conveyances (pipes, culverts, etc.) that
rran���rt «��TTc
Version: December 2013 Page 9

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

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

ATTACHMENT A
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
NCDOT; ATTN: Jeff Hemphill, Natural Environment Section
1598 Mail Service Center; Raleigh, NC 27699-1598
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: Fors�h Clt)/: Kernersville
Center coordinates of site (lat/long in degree decimal format):
Lat. 36.111732 °N; LOng. 80.106633 °W,
Universal Transverse Mercator: ��
Name of nearest waterbody: sm�m creek, Kerners Mill Creek
Identify (estimate) amount of waters in the review area:
Non-wetland waters:
��,448 linear feet: 3-z5 width (ft) and/or 1.63 acres.
COWaI'CIIII CIaSS: Riverine, Lacustrine (PA, PI)
Str@alll FIOW: PER (Kerners Mill Ck, Smith Ck, SD, SH-SJ, SN-SP, SS, SU-SW), INT (SA, SB, SG, SN, SR, ST, SX)
WetlallClS: 3•84 acres.
COWafC�lll C�aSS: Palustrine
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal: NiA
Non-Tidal: NiA
1

E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
� Office (Desk) Determination. Date:
� Field Determination. Date(s):
SUPPORTING DATA. Data reviewed for preliminary JD
(check all that apply - checked items should be included in case file and,
where checked and requested, appropriately reference sources below):
� Maps, plans, plots or plat submitted by or on behalf of the
applicant/consultant: Nc�oT
❑ Data sheets prepared/submitted by or on behalf of the
appl�nt/consultant.
Office concurs with data sheets/delineation report.
� Office does not concur with data sheets/delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
� USGS NHD data
� USGS 8 and 12 digit HUC maps
❑✓ U.S. Geological Survey map(s). Cite scale & quad name:1:24,000 -(see °Other"�
❑✓ USDA Natural Resources Conservation Service Soil Survey.
Cltatl011: Forsyth County, 1976
❑ National wetlands inventory map(s). Cite name:
❑ State/Local wetland inventory map(s):
❑ FEMA/FIRM maps:
� 100-year Floodplain Elevation is:
(National Geodectic Vertical Datum of 1929)
❑✓ Photographs: ❑✓ A@rlal �Na111@ 8c Dat@�: NC Statewide Orthoimagery Project (2014) OC
� Other (Name & Date):
� Previous determination(s). File no. and date of response letter:
� Other information (please specify): W�nston-sa�em East, Kernersville, & Belews Creek Quads
�

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.
3

This preliminary JD finds that there "may be" waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be
affected by the proposed activity, based on the following information:
IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified bv the Corps and should not be relied upon for
later iurisdictional determinations.
Signature and date of
Regulatory Project Manager
(REQUIRED)
4
S n d date of �
per questing prelimin
(REQUIRED, unless obtaining
the signature is impracticable)

Estimated Class of
Site Latitude Longitude Cowardin amount of aquatic
number Class aquatic resource
resource
in review area
Kerners 36.1268 -80.1151 Riverine 1 075 linear feet non-section 10
Mill Creek ' - non-tidal
Smith Creek 36.1097 -80.1089 Riverine 4,432 linear feet non-section 10
- non-tidal
SA 36.1092 -80.0888 Riverine lO linear feet non-section 10
- non-tidal
SB 36.1080 -80.1034 Riverine 275 linear feet non-section 10
- non-tidal
SD 36.1136 -80.1056 Riverine 1,775 linear feet non-section 10
- non-tidal
SG 36.1114 -80.1146 Riverine 1641inear feet non-section 10
- non-tidal
SH 36.1113 -80.1220 Riverine 5661inear feet non-section 10
- non-tidal
SI 36.1113 -80.1209 Riverine 4261inear feet non-section 10
- non-tidal
SJ 36.1125 -80.1043 Riverine 1,252 linear feet non-section 10
- non-tidal
SM 36.1127 -80.1149 Riverine 531 linear feet non-section 10
- non-tidal
SN 36.1262 -80.1125 Riverine 1,441 linear feet non-section 10
- non-tidal
SO 36.1368 -80.1153 Riverine 21 linear feet non-section 10
- non-tidal
SP 36.1342 -80.1223 Riverine 73 linear feet non-section 10
- non-tidal
SR 36.1341 -80.1151 Riverine 361inear feet non-section 10
- non-tidal
SS 36.1286 -80.1151 Riverine 2,420 linear feet non-section 10
- non-tidal
ST 36.1335 -80.1155 Riverine 91 linear feet non-section 10
- non-tidal
SU 36.1332 -80.1154 Riverine 131 linear feet non-section 10
- non-tidal
SV 36.1242 -80.1128 Riverine 1,9941inear feet non-section 10
- non-tidal
SW 36.1236 -80.1129 Riverine 351 linear feet non-section 10
- non-tidal
SX 36.1094 -80.0903 Riverine 471inear feet non-section 10
- non-tidal
ESE-S38 36.1122 -80.1147 Riverine 1351inear feet non-section 10
- non-tidal

ESE-S41 36.1122 -80.1147 Riverine 202 linear feet non-section 10
- non-tidal
PA 36.1141 -80.1051 Lacustrine 0.13 acre non-section 10
- non-tidal
PI 36.1250 -80.1110 Lacustrine 1.51 acres non-section 10
- non-tidal
WA 36.1079 -80.1067 Palustrine 0.55 acre non-section 10
-wetland
WB 36.1110 -80.1138 Palustrine 0.87 acre non-section 10
-wetland
WD 36.1113 -80.1132 Palustrine 0.17 acre non-section 10
-wetland
WE 36.1139 -80.1252 Palustrine 0.11 acre non-section 10
-wetland
WF 36.1254 -80.1118 Palustrine 0.11 acre non-section 10
-wetland
WG 36.1343 -80.1223 Palustrine 0.03 acre non-section 10
-wetland
WH 36.1341 -80.1223 Palustrine 0.02 acre non-section 10
-wetland
WI 36.1271 -80.1125 Palustrine 0.96 acre non-section 10
-wetland
WJ 36.1263 -80.1124 Palustrine 0.11 acre non-section 10
-wetland
WL 36.1337 -80.1152 Palustrine 0.003 acre non-section 10
-wetland
WM 36.1336 -80.1153 Palustrine 0.006 acre non-section 10
-wetland
WN 36.1337 -80.1157 Palustrine 0.01 acre non-section 10
-wetland
WO 36.1284 -80.1150 Palustrine 0.11 acre non-section 10
-wetland
WQ 36.1270 -80.1139 Palustrine 0.04 acre non-section 10
-wetland
WR 36.1269 -80.1143 Palustrine 0.06 acre non-section 10
-wetland
WS 36.1271 -80.1156 Palustrine 0.43 acre non-section 10
-wetland
ESE-W20 36.1118 -80.1214 Palustrine 0.14 acre non-section 10
-wetland
ESE-W21 36.1120 -80.1214 Palustrine 0.03 acre non-section 10
-wetland
ESE-W22 36.1115 -80.1131 Palustrine 0.08 acre non-section 10
-wetland

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Figure 1: Vicinity Map
TI P U-5760
Widen Big Mill Farm Road and Hopkins Road from
south of I-40 Business/US 421 to West Mountain Street
Kernersville, Forsyth County

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TI P U-5760
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TIP U-5760
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south of I-40 Business/US 421 to West Mountain Street
Kernersville, Forsyth County

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Figure 4: NRCS Soil Survey Map
TI P U-5760
Widen Big Mill Farm Road and Hopkins Road from
south of I-40 Business/US 421 to West Mountain Street
Kernersville, Forsyth County

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 2/2/2016 ProjecUSite: TIP U-5760 Latitude: 36.126744
Kerners Mill Creek
EValUat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115208
Kimley-Horn
Total Points: 41 Stream Determination (ci Other
Stream is at least intermittent Ephemeral Intermitte Perennial e.g. Quad Name: BeIeWS Cf22k
if >_ 19 or perennial if Z 30
A. Geomorphology Subtotal = 25 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 3
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 3
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 0
10. Natural valley 0 0.5 1 1.5 1
11. Second or reater order channel No = 0 Yes = 3 3
artificial ditches are not rated; see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 1
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Kerners Mill Creek is a strong perennial channel with a sandy
substrate and areas of exposed clay in the bank. The banks are steep and the
stream is incised. It appears that berms were built along the stream west of
Hopkins Road to control flooding.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 02/02/2016
5. Name ot'stream: Kerners Mill Creek
7. Approximate drainage area: 1,800 acres
9. Length ofreach evaluated: 1,100 linear feet
11. Site coordinates (if known): prefer in decimal degrees.
Latituae �eX. 34.s�asia>: 36.126744
4. Time of evaluation: 4:30 pm
6. River basin: YaClkln
8. Stream order:,TI111'CI OI'det'
10. County: F01"S�il
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i>: -80.115208
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated north of Timberwood Trl on each side of Hopkins Rd
14. Proposed channel work (if any): NOne
15. Recent weather conditions: Tf12 df ea I'2CeIVeCI 0.03" of rain the day prior to the site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ 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
21. Estimated watershed land use: 60 % Residential 25 % Commercial _% Industrial _% Agricultural
15 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 20� 23. Bank height (from bed to top of bank): 7�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 58 Comments:
Kerners Mill Creek is a strongperennial channel with a sandy substrate and areas of exposed clay in the bank. The banks are
steep and the stream is incised. It appears that berms were built along the stream west of Hopkins Road to control flooding.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 02/02/2016
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 ratio or requirement. Form subject to change — version 06/03. To Comment, please ca11919-876-8441 x 26.

Kerners Mill Creek
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 2
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 4
�, Presence of adjacent floodplain 3
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 Q
(deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands 3
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 4
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures 3
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production 3
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity 3
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 4
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 3
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 58
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.109582
Smith Creek
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.107828
Kimley-Horn
Total Points: 38.5 Stream Determination (cir Other
Stream is at least intermittent Ephemeral Intermitten erennial e.g. Quad Name: K2fflefSVlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 23 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 2
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 2
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or reater order channel No = 0 Yes = 3 3
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 9.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Smith Creek is a perennial channel within a natural valley. Smith
Creek is deeply incised and multiple bank failures were observed along the
channel. A floodplain wetland was documented along Smith Creek within the
project corridor, but the floodplain is mostly drained.

USACE AID# DWQ # Site # (indicate on attached map)
;,�,; STREAM QUALITY ASSESSMENT WORKSHEET �� �,�
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/26/2016
5. Name of stream: SI'Yllth CI'2ek
7. Approximate drainage area: 1,650 acres
9. Length ofreach evaluated: 1,500 linear feet
11. Site coordinates (if known): prefer in decimal degrees.
Latituae �eX. 34.s�asia>: 36.109582
4. Time of evaluation: 11:30 am
6. River basin: YaClkln
8. Stream order:, SeC011CI OI'Clef
10. County: F01"S�il
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i>: -80.107828
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated west of Harmon Creek Rd's deadend and north of High Creek Ct
14. Proposed channel work (if any): NOne
15. Recent weather conditions: MOStIy SU1111y dnCl COOI WItI1 n0 f dln WItI1111 4H IlOUI'S pf IOC t0 SIt2 VISIt
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES If yes, estimate the water surface area: 4.5 acres
19. Does channel appear on USGS quad map? YES 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 30 % Residential 30 % Commercial _% Industrial 5% Agricultural
30 % Farested _% Cleared / Logged 5°io otner � Paved Roadway �
22. Bankfull width: 25� 23. Bank height (from bed to top of bank): 8�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 54 Comments:
Smith Creek is a perennial channel within a natural valley. Smith Creek is deeply incised and multiple bank failures were
observed along the channel. A floodplain wetland was documented along Smith Creek within the project corridor, but the
floodplain is mostly drained.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/26/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Smith Creek
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 3
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain 3
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 1
p"' (deeply entrenched = 0; frequent flooding = max points)
g Presence of adjacent wetlands 0— 6 0— 4 0— 2 1
no wetlands = 0; lar e ad'acent wetlands = max oints
9 Channel sinuosity 0— 5 0— 4 0— 3 4
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 1
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 1
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 2
E�
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 2
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6 4
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 4
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 4
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 54
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.109150
Stream SA
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.088755
Kimley-Horn
Total Points: 24 Stream Deter ' ' (circle one) Other
Stream is at least intermittent Ephemera ntermitten erennial e.g. Quad Name: K2fflefSVlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 7 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 0
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 0
poolsequence
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 1.5
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 11
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 3
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0
16. Organic debris lines or piles 0 0.5 1 1.5 0.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SA is an intermittent stream channel that is mostly piped and
only daylights within the project corridor for - 10'. The channel is linear. There
was strong flow during the site visit, but likely due to snow/ice melt from recent
snow event.

USACE AID# DWQ # Site # (indicate on attached map)
;,�,; STREAM QUALITY ASSESSMENT WORKSHEET �� �,�
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/26/2016
5. Name of stream: StC2at71 SA
7. Approximate drainage area: iS aCl'eS
9. Length ofreach evaluated: 1O Ilneal' f2et
11. Site coordinates (if known): prefer in decimal degrees.
Latituae �eX. 34.s�asia>: 36.109150
4. Time of evaluation: 9� 00 a m
6. River basin: YaClkln
8. Stream order:, FII'St OI'der
10. County: F01"S�il
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i>: -80.088755
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
Stream SA daylights in the corridor for 10' just south of Business I 40 and north of Arbor Hill Rd
14. Proposed channel work (if any): NOne
15. Recent weather conditions: Mostly sunny and cool with no rain within 48 hours prior to site visit, but snow/ice was on the ground
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? NO
21. Estimated watershed land use: _% Residential 85 % Commercial _% Industrial _% Agricultural
5% Farested _% Cleared / Logged 10 °ro otner � Paved Road �
22. Bankfull width: 12� 23. Bank height (from bed to top of bank): 4�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): �� Comments:
Stream SA is an intermittent stream channel that is mostl�piqed and only da�4hts within the project corridor for � 10'. The
channel is linear. There was strong flow during the site visit, but likely due to snow/ice melt from recent snow event.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/26/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SA
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 �
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 Q
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 2
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 Q
(deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 Q
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 2
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures 3
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 1
E�
� Impact by agriculture, livestock, or timber production O
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 Q
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity O
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 Q
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 2
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 20
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.108034
Stream SB
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.103405
Kimley-Horn
Total Points: 28•5 Stream Determination (circle one) Other
Stream is at least intermittent Ephemera ntermitten erennial e.g. Quad Name: K2fflefSVlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 15.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 1
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 2
poolsequence
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 2
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1
11. Second or reater order channel No = 0 Yes = 3 3
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal =
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0
16. Organic debris lines or piles 0 0.5 1 1.5 0.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SB is a strong intermittent channel that has been mostly
piped under expansive commercial development. The stream is daylighted on
each side of Harmon Creek Road in fenced off natural areas that have steep
topography sloping towards the stream. Moderate baseflow was observed within
the channel, but is likely influenced by melting snow/ice from previous week.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET � ,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name• NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/26/2016
5. Name of stream: St1'2at11 SB
4. Time of evaluation: 1�:00 am
6. River basin: YaClkln
7. Approximate drainage area: 3S aCl'eS 8. Stream order:, SeC011CI OI'Clef
9. Length ofreach evaluated: 27S IIIl2al' feet 10. County: F01'S�il
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): N�A
Latitude �eX. 34.s�asia>: 36.108034 Lon�itude �eX.-��.ss66ii>: -80.103405
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
SB was evaluated on each side of Harmon Creek Road between the Wal-Mart Supercenter and Lowes Home Improvement
14. Proposed channel work (if any): NOne
15. Recent weather conditions: MOStIy SU1111y dnCl COOI WItI1 n0 f dln WItI1111 4H IlOUI'S pf IOC t0 SIt2 VISIt
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters � Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ 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
21. Estimated watershed land use: _% Residential 85 % Commercial _% Industrial _% Agricultural
5% Farested _% Cleared / Logged 10 °io otner � Paved Roadway �
22. Bankfull width: 8� 23. Bank height (from bed to top of bank): 6�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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 scare of 100 representing a stream of the
highest quality.
Total Score (from reverse): 32 Comments:
Stream SB is a strong intermittent channel that has been mostl rLpiped under expansive commercial development. The stream
is da r�l�iahted on each side of Harmon Creek Road in fenced off natural areas that have steep topo4raphy sloping towards the
stream. Moderate baseflow was observed within the channel, but is likely influenced by melting snow/ice from previous week.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/26/2016
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 ratio or requirement. Form subject to change — version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SB
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 3
2 Evidence of past human alteration 0— 6 0— 5 0— 5 �
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 2
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 Q
(deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 1
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 1
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 1
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 3
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6 1
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 3
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 2
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 32
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.113614
Stream SD
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.105637
Kimley-Horn
Total Points: 34.5 Stream Determination (cir Other
Stream is at least intermittent Ephemeral Intermitten erennial e.g. Quad Name: K2fflefSVlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 18 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 0
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 1
11. Second or reater order channel No = 0 Yes = 3 3
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 10.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SD is a perennial channel within a well-defined natural valley.
SD is slightly downcut and multiple bank failures were observed south of
Business I 40. Numerous animal tracks were observed in and around SD.

USACE AID# DWQ # Site # (indicate on attached map)
;,�,; STREAM QUALITY ASSESSMENT WORKSHEET �� �,�
Provide the following information for the stream reach under assessment: �,
1. Applicant's name• NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/26/2016
5. Name of stream: StC2at71 SD
4. Time of evaluation: 11:00 am
6. River basin: YaClkln
7. Approximate drainage area: 161 aCreS 8. Stream order:, SeC011CI OI'Clef
9. Length ofreach evaluated: 1,700 linear feet 10. County: F01'S�il
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): N�A
Laritude �eX. 34.s�2312>: 36.113614 Longitude �eX. -��.ss66� �>: -80.105637
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated just south of Business I 40 from the culvert outlet to its confluence with Smith Creek
14. Proposed channel work (if any): NOne
15. Re�ent Weatner �ona�t�ons: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES If yes, estimate the water surface area: 0.13 acres
19. Does channel appear on USGS quad map? YES 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 45 % Residential 10 % Commercial _% Industrial _% Agricultural
35 ��o Farested _% Cleared / Logged 10 °io otner � Paved Roadway �
22. Bankfull width: 10� 23. Bank height (from bed to top of bank): 4�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 51 Comments:
Stream SD is a perennial channel within a well-defined natural valley. SD is slightly downcut and multiple bank failures were
observed south of Business I 40. Numerous animal tracks were observed in and around SD.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/26/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SD
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 3
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain 1
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 1
p"' (deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 1
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 2
E�
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 2
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6 4
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 4
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 4
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 51
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/26/2016 Project/Site: TIP U-5760 Latitude: 36.111608
Stream SG
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.114586
Kimley-Horn
Total Points: 25 Stream Determi 'on (circle one) Other
Stream is at least intermittent Ephemera ntermitten erennial e.g. Quad Name: K2fflefSVlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 8.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 2
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 1
poolsequence
4. Particle size of stream substrate 0 1 2 3 1
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 10.5
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 3
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SG is a short incised feature that drains a large pond/wetland
system. SG forms just upstream of a farm road crossing. Strong iron oxidizing
bacteria observed within the channel. SG likely does not flood unless Smith
Creek overtops its bank.

USACE AID# DWQ # Site # (indicate on attached map)
;,�,; STREAM QUALITY ASSESSMENT WORKSHEET �� �,�
Provide the following information for the stream reach under assessment: �,
1. Applicant's name• NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/26/2016
5. Name of stream: StC2at71 SG
4. Time of evaluation: 1�:15 am
6. River basin: YaClkln
7. Approximate drainage area: 39 aCreS 8. Stream order:, FII'St OI'der
9. Length ofreach evaluated: 16O IIIl2al' feet 10. County: F01'S�il
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): N�A
Laritude �eX. 34.s�2312>: 36.111608 Longitude �eX. -��.ss66� �>: -80.114586
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated south of Business I 40 and east of Bluff School Road
14. Proposed channel work (if any): NOne
15. Re�ent Weatner �ona�t�ons: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ 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
21. Estimated watershed land use: 35 % Residential _% Commercial _% Industrial _% Agricultural
50 % Farested 15 % Cleared / Logged _% Other ( )
22. Bankfull width: 8� 23. Bank height (from bed to top of bank): 4�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 33 Comments:
Stream SG is a short incised feature that drains a large pond/wetland system. SG forms just upstream of a farm road crossin4.
Strong iron oxidizing bacteria observed within the channel. SG likely does not flood unless Smith Creek overtops its bank.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/26/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SG
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 2
2 Evidence of past human alteration 0— 6 0— 5 0— 5 2
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 Q
(deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = maa� oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 1
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 1
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 2
E�
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 2
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 1
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6 2
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 2
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 33
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/27/2016 Project/Site: TIP U-5760 Latitude: 36.111630
Stream SH
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.121753
Kimley-Horn
Total Points: 36.5 Stream Determination (circle one) Other
Stream is at least intermittent Ephemeral Intermitte 2r2flllla .g. Quad Name: K2fflefSVlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 22.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or reater order channel No = 0 Yes = 3 3
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 2
19. Rooted upland plants in streambed 3 2 1 0 2
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SH is a meandering stream in a large topographic
crenulation. The banks are mostly stable due to tree roots, but occasional
failures are present along the reach. Large grade change between origin and
culvert has contributed to multiple headcuts in upper reach. Wetlands are
present along the lower reach.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name• NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/27/2�16
5. Name of stream: StC2at71 SH
4. Time of evaluation: 1�:15 am
6. River basin: YaClkln
7. Approximate drainage area: SS aCl'eS 8. Stream order:, SeC011CI OI'Clef
9. Length ofreach evaluated: SOO IIIl2al' feet 10. County: F01'S�il
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): N�A
Laritude �eX. 34.s�2312>: 36.111630 Longitude �eX. -��.ss66� �>: -80.121753
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated south of Business I 40 and east of Bluff School Road
14. Proposed channel work (if any): NOne
15. Re�ent Weatner �ona�t�ons: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:.
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 35 % Residential _% Commercial _% Industrial _% Agricultural
50 % Farested 15 % Cleared / Logged _% Other ( )
22. Bankfull width: 5�-10� 23. Bank height (from bed to top of bank): 3�-5�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 51 Comments:
Stream SH is a meandering stream in a large topo4raphic crenulation. The banks are mostly stable due to tree roots, but
occasional failures are present along the reach. Large grade change between origin and culvert has contributed to multiple
headcuts in u�per reach. Wetlands are present along the lower reach.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/27/2016
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 ratio or requirement. Form subject to change — version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SH
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 3
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 �}
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain 1
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 1
p"' (deeply entrenched = 0; frequent flooding = max points)
g Presence of adjacent wetlands 0— 6 0— 4 0— 2 1
no wetlands = 0; lar e ad'acent wetlands = max oints
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = maa� oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 1
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 2
E�
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 2
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity 3
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 4
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 3
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 51
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/27/2016 Project/Site: TIP U-5760 Latitude: 36.111453
Stream SI
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.120901
Kimley-Horn
Total Points: 25 Stream Determination (circ ne) Other
Stream is at least intermittent Ephemeral Intermitte Perennial .g. Quaa rvame: Kernersville
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 8.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 2
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 1
poolsequence
4. Particle size of stream substrate 0 1 2 3 1
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 10.5
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 3
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SI is a perennial stream that intersects with stream SH. The
stream has a strong baseflow and a steep grade change further upslope from
the confluence with SH.

USACE AID# DWQ # Site # (indicate on attached map)
;,�,; STREAM QUALITY ASSESSMENT WORKSHEET �� �,�
Provide the following information for the stream reach under assessment: �,
1. Applicant's name• NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/27/2�16
5. Name of stream: StC2at71 SI
4. Time of evaluation: 1�:40 am
6. River basin: YaClkln
7. Approximate drainage area: 24 aCreS 8. Stream order:, FII'St OI'der
9. Length ofreach evaluated: 4OO IIIl2al' feet 10. County: F01'S�il
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): N�A
Laritude �eX. 34.s�2312>: 36.111453 Longitude �eX. -��.ss66� ��: -80.120901
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated south of Business I 40 and east of Bluff School Road
14. Proposed channel work (if any): NOne
15. Re�ent Weatner �ona�t�ons: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:.
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 35 % Residential _% Commercial _% Industrial _% Agricultural
50 % Farested 15 % Cleared / Logged _% Other ( )
22. Bankfull width: 3�-6� 23. Bank height (from bed to top of bank): 1�-10�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 42 Comments:
Stream SI is a perennial stream that intersects with stream SH. The stream has a strong baseflow and a stee�4rade change
further upslope from the confluence with SH.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/27/2016
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 ratio or requirement. Form subject to change — version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SI
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 2
2 Evidence of past human alteration 0— 6 0— 5 0— 5 4
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 �}
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 Q
(deeply entrenched = 0; frequent flooding = max points)
g Presence of adjacent wetlands 0— 6 0— 4 0— 2 2
no wetlands = 0; lar e ad'acent wetlands = max oints
9 Channel sinuosity 0— 5 0— 4 0— 3 2
extensive channelization = 0; natural meander = maa� oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 1
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 1
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production 3
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 1
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity 3
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 2
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 2
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 42
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/27/2016 Project/Site: TIP U-5760 Latitude: 36.112541
Stream SJ
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.104295
Kimley-Horn
Total Points: 42.5 Stream Determination c' e Other
Stream is at least intermittent Ephemeral Intermitt t Perennial .g. Quaa rvame: Kernersville
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 25 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 2
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or reater order channel No = 0 Yes = 3 3
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 0
15. Sediment on plants or debris 0 0.5 1 1.5 1.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = 7.5
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 1.5
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SJ is a strong perennial stream beginning offsite. SJ flows
over bedrock with numerous boulders and rock formations observed within the
channel. Small fish were observed throughout the channel in the deeper pools.
Large depositional bars and benches were found throughout the reach. The
stream is deeply incised with numerous bank failures.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET � ,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/27/2�16
5. Name of stream: St1'2at11 S�
7. Approximate drainage area: 97 aCl'eS
9. Length ofreach evaluated: 1,200 linear feet
11. Site coordinates (if known): prefer in decimal degrees.
Latituae �eX. 34.s�asia>: 36.112541
4. Time of evaluation: 8�30 pm
6. River basin: YaClkln
8. Stream order:, SeC011CI OI'Clef
10. County: F01"S�il
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i>: -80.104295
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated north of Business I 40 beginning at the confluence with SD then heading upstream
14. Proposed channel work (if any): NOne
15. Recent weather conditions: MOStIy SU1111y dnCl COOI WItI1 n0 f dln WItI1111 4H IlOUI'S pf IOC t0 SIt2 VISIt
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters � Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ 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
21. Estimated watershed land use: 30 % Residential 20 % Commercial _% Industrial _% Agricultural
45 ��o Farested _% Cleared / Logged 5°io otner � Paved Roadway �
22. Bankfull width: 25� 23. Bank height (from bed to top of bank): 6�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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 scare of 100 representing a stream of the
highest quality.
Total Score (from reverse): 52 Comments:
Stream SJ is a strongperennial stream beginning offsite. SJ flows over bedrock with numerous boulders and rock formations
observed within the channel. Small fish were observed throughout the channel in the deeper pools. Large depositional bars
and benches were found throughout the reach. The stream is deeply incised with numerous bank failures.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/27/2016
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 ratio or requirement. Form subject to change — version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream S]
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 3
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain 2
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 1
p"' (deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = maa� oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 1
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 2
E�
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 2
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity 3
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 4
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 2
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 3
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 52
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/27/2016 Project/Site: TIP U-5760 Latitude: 36.112611
Stream SM
EV81U8t01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115224
Kimley-Horn
Total Points: 31.5 Stream Determination (cir Other
Stream is at least intermittent Ephemeral Intermitten erennial e.g. Quad Name: Kel't121'Svlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 16.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 1
. n-c anne structure: ex. ri le-pool, step-poo ,
ripple-pool sequence 0 1 2 3 3
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1.5
10. Natural valley 0 0.5 1 1.5 0
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated; see discussions in manual
B. Hydrology Subtotal = g
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizin bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = g
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SM is a well-defined perennial channel flowing along the
western edge of pond PK. The stream appears to have been relocated and does
not flow through the man-made fish hatchery ponds. Strong flow was observed
within SM along with good structure development and substrate sorting in bed.
Few trees or shrubs alonq the reach.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET � ,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2. Evaluator's name: R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/27/2016 4. Time of evaluation: 5:15 pm
5. Name of stream: St1'2at11 SM 6. River basin: YaClkln
7. Approximate drainage area: 6O aCl'eS 8. Stream order:, FII'St OI'der
9. Length ofreach evaluated: 6OO IIIl2al' feet 10. County: F01'S�il
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): N�A
Laritude �eX. 34.s�z3iz>: 36.112611 Lon�itude �eX.-��.ss66ii�: -80.115224
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated north of Business I 40 along the western edge of pond PK
14. Proposed channel work (if any): NOne
15. Recent weather conditions: MOStIy SU1111y dnCl COOI WItI1 n0 f dln WItI1111 4H IlOUI'S pf IOC t0 SIt2 VISIt
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from mid-30s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters � Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ 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
21. Estimated watershed land use: 30 % Residential 20 % Commercial _% Industrial _% Agricultural
45 ��o Farested _% Cleared / Logged 5°io otner � Paved Roadway �
22. Bankfull width: 5� 23. Bank height (from bed to top of bank): 2�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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 scare of 100 representing a stream of the
highest quality.
Total Score (from reverse): 30 Comments:
Stream SM is a well-defined perennial channel flowing along the western edge of pond PK. The stream appears to have been
relocated and does not flow through the man-made fish hatcherXponds. Strong flow was observed within SM along with Qood
structure development and substrate sorting in bed. Few trees or shrubs along the reach.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/27/2016
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 ratio or requirement. Form subject to change — version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SM
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 �
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 Q
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 Q
(deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 2
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 2
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 2
E�
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 1
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity O
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 Q
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 30
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.123129
Stream SN-INT
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.109154
Kimley-Horn
Total Points: 26 Stream Deter ' ' n(circle one) Other
Stream is at least intermittent Ephemera ntermitten erennial e.g. Quad Name: K2fflefSVlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 14 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 2
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 2
poolsequence
4. Particle size of stream substrate 0 1 2 3 1
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 1
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal =
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 0.5
15. Sediment on plants or debris 0 0.5 1 1.5 1
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 0
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 1
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SN-Intermittent begins at a headcut downslope from multiple
stormwater outlets. The channel is confined by residential development on all
sides and multiple bank failures are present along the reach.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/28/2016
5. Name of stream: Str2am SN-INTERMITTENT
7. Approximate drainage area: 3O aCl'eS
9. Length ofreach evaluated: 73S IIIl2al' feet
11. Site coordinates (if known): prefer in decimal degrees.
Latituae �eX. 34.s�asia>: 36.123129
4. Time of evaluation: 1�:00 am
6. River basin: YaClkln
8. Stream order:, FII'St OI'der
10. County: F01"S�il
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i�: -80.109154
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated from its origin just north of Ashley Park Dr to the culvert inlet at Woodfield Dr
14. Proposed channel work (if any): NOne
15. Recent weather conditions: MOStIy SU1111y a1lCI COOI WItI1 ^��.�1�� of rain the night prior to site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 75 % Residential _% Commercial _% Industrial _% Agricultural
25 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 4� 23. Bank height (from bed to top of bank): 1�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 43 Comments:
Stream SN-Intermittent begins at a headcut downslope from multiple stormwater outlets. The channel is confined by
residential development on all sides and multiple bank failures are present along the reach.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/28/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SN-INTERMITTENT
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 3
2 Evidence of past human alteration 0— 6 0— 5 0— 5 �
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 1
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain 2
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 2
p"' (deeply entrenched = 0; frequent flooding = max points)
g Presence of adjacent wetlands 0— 6 0— 4 0— 2 2
no wetlands = 0; lar e ad'acent wetlands = max oints
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 1
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 2
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 2
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 2
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 1
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 3
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6 2
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 3
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 2
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 43
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.126193
Stream SN-PER
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.112487
Kimley-Horn
Total Points: 32 Stream Determination (cir Other
Stream is at least intermittent Ephemeral Intermitten erennial e.g. Quad Name: Be12WS Cf2ek
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 16.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal =
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = 6.5
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0.5
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: SN-PER is the reach of SN downslope of a large (1.5 acre) pond
outlet . Flow is strong and the channel is well-defined. The culvert outlet
draining from upslope pond is perched - 4' above stream bed. Much of the
reach has been channelized into a ditch along Hopkins Road until the
confluence with Kerners Mill Creek.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/28/2016
5. Name of stream: Stream SN-PERENNIAL
7. Approximate drainage area: S7 aCl'eS
9. Length ofreach evaluated: 788 IIIl2al' feet
11. Site coordinates (if known): prefer in decimal degrees.
Latitude �eX. 34.s�asia>: 36.126193
4. Time of evaluation: 12:30 pm
6. River basin: YaClkln
8. Stream order:, FII'St OI'der
10. County: F01"S�il
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i�: -80.112487
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated downslope from large man-made pond east of Hopkins Rd
14. Proposed channel work (if any): NOne
15. Recent weather conditions: MOStIy SU1111y a1lCI COOI WItI1 ^��.�1�� of rain the night prior to site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters � Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES If yes, estimate the water surface area: 1.5 acres
19. Does channel appear on USGS quad map? YES 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 40 % Residential _% Commercial _% Industrial _% Agricultural
60 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 4� 23. Bank height (from bed to top of bank): 1�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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 scare of 100 representing a stream of the
highest quality.
Total Score (from reverse): 47 Comments:
SN-PER is the reach of SN downslope of a large (1.5 acreZpond outlet . Flow is strong and the channel is well-defined. The
culvert outlet draining from upslope pond is perched � 4' above stream bed. Much of the reach has been channelized into a
ditch along Hopkins Road until the confluence with Kerners Mill Creek.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/28/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SN-PERENNIAL
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 1
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 2
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 2
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain 2
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 2
p"' (deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands 3
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 3
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 2
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 2
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures 3
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 2
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6 1
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 1
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 2
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 2
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 47
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.136791
Stream SO
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115314
Kimley-Horn
Total Points: 33.5 Stream Determination (cir Other
Stream is at least intermittent Ephemeral Intermitten erennial e.g. Quad Name: Be12WS Cf2ek
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 16 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 1
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 2
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 3
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 11.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 1.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SO begins at a large headcut below multiple overland
drainage flows. SO is deeply incised and intercepts groundwater. The channel
has incised down to a clay layer that appears more resistant to erosion than the
upper layers of soil.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/28/2016
5. Name of stream: StC2at71 SO
7. Approximate drainage area: iH aCl'eS
9. Length ofreach evaluated: 39 Ilneal' f2et
11. Site coordinates (if known): prefer in decimal degrees.
Latitude �eX. 34.s�asia>: 36.136791
4. Time of evaluation: 4:30 pm
6. River basin: ROaftOke
8. Stream order:, FII'St OI'der
10. County: F01"S�h
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i�: -80.115314
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated north of NC 66 and west of Fulp Rd
14. Proposed channel work (if any): NOne
15. Recent weather conditions: MOStIy SU1111y a1lCI COOI WItI1 ^��.�1�� of rain the night prior to site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: _% Residential 85 % Commercial _% Industrial _% Agricultural
15 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 6� 23. Bank height (from bed to top of bank): 8�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 38 Comments:
Stream SO begins at a large headcut below multiple overland drainage flows. SO is deeply incised and intercepts Qroundwater.
The channel has incised down to a clay layer that appears more resistant to erosion than the upper layers of soil.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/28/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SO
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 3
2 Evidence of past human alteration 0— 6 0— 5 0— 5 4
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 2
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 Q
(deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 1
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 Q
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 1
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 2
E�
� Impact by agriculture, livestock, or timber production 3
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 3
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6 1
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 4
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 38
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.134176
Stream SP
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.122372
Kimley-Horn
Total Points: 32 Stream Determination (cir Other
Stream is at least intermittent Ephemeral Intermitten erennial e.g. Quad Name: Be12WS Cf2ek
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 16 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 2
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 2
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 0
10. Natural valley 0 0.5 1 1.5 1
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SP is a perennial feature that begins at a culvert outlet that
drains multiple wash bays at a large industrial concrete mixing plant. The
stream is incised and has little woody riparian vegetation within the project
study area. The grass is mowed/maintained up to the stream banks.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 01/28/2016
5. Name of stream: StC2at71 SP
7. Approximate drainage area: ZS aCl'eS
9. Length ofreach evaluated: 93 Ilneal' f2et
11. Site coordinates (if known): prefer in decimal degrees.
Latituae �eX. 34.s�asia>: 36.134176
4. Time of evaluation: 5:00 pm
6. River basin: YaClkln
8. Stream order:, FII'St OI'der
10. County: F01"S�il
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i>: -80.122372
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated north of W Mountain St between Loflin Concrete and Cash Elementary School
14. Proposed channel work (if any): NOne
15. Recent weather conditions: MOStIy SU1111y a1lCI COOI WItI1 ^��.�1�� of rain the night prior to site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed ,�V (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: _% Residential 85 % Commercial _% Industrial _% Agricultural
15 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 5� 23. Bank height (from bed to top of bank): 4�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 32 Comments:
Stream SP is a perennial feature that begins at a culvert outlet that drains multiple wash bays at a large industrial concrete
mixingplant. The stream is incised and has little woody riparian vegetation within the project study area. The grass is
mowed/maintained up to the stream banks.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 01/28/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SP
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 1
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 Q
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 1
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 2
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 Q
(deeply entrenched = 0; frequent flooding = max points)
g Presence of adjacent wetlands 0— 6 0— 4 0— 2 2
no wetlands = 0; lar e ad'acent wetlands = max oints
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 1
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 2
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 2
E�
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 1
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity O
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 2
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 32
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 2/2/2016 Project/Site: TIP U-5760 Latitude: 36.134117
Stream SR
EV81U8t01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115122
Kimley-Horn
Total Points: 19.5 Stream Deter ' ' n(circle one) Other
Stream is at least intermittent Ephemer Intermitten erennial e.g. Quad Name: Be12wS CI'2ek
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 7.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 2
2. Sinuosity of channel along thalweg 0 1 2 3 1
3. n-channel structure: ex. ri le-pool, step-pool,
ripple-pool sequence 0 1 2 3 1
4. Particle size of stream substrate 0 1 2 3 1
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 0
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 1.5
10. Natural valley 0 0.5 1 1.5 0
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated; see discussions in manual
B. Hydrology Subtotal = g
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizin bacteria 0 1 2 3 2
14. Leaf litter 1.5 1 0.5 0 0
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 0.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = 4
18. Fibrous roots in streambed 3 2 1 0 1
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SR is a short, weak intermittent stream that crosses a
utility easement. The water in the feature appears to be artificially perched by
the utility easement construction.

USACE AID# DWQ # Site # (indicate on attached map)
;,�,; STREAM QUALITY ASSESSMENT WORKSHEET ��,�.
Provide the following information for the stream reach under assessment: �
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 02/02/2016
5. Name of stream: StC2at71 SR
7. Approximate drainage area: 3 aCl"eS
9. Length ofreach evaluated: 3J Ilneal' f2et
11. Site coordinates (if known): prefer in decimal degrees.
Latituae �eX. 34.s�asia>: 36.134117
4. Time of evaluation: 1�:30 am
6. River basin: YaClkln
8. Stream order:, FII'St OI'der
10. County: F01'S�h
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i�: -80.115122
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated south of NC 66 and west of Stanley Farm Rd
14. Proposed channel work (if any): NOne
15. Recent weather conditions: Tf12 df ea I'2CeIVeCI 0.03" the day prior to the site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? NO
21. Estimated watershed land use: 25 % Residential _% Commercial _% Industrial _% Agricultural
75 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 4� 23. Bank height (from bed to top of bank): 0.5�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 30 Comments:
Stream SR is a short, weak intermittent stream that crosses a utility easement. The water in the feature appears to be
artificiall�perched by the utility easement construction.
Evaluator's Signature `�`9 �'' `�`'`'�`'`�`a"'' Date 02/02/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SR
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 3
2 Evidence of past human alteration 0— 6 0— 5 0— 5 �
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 1
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 2
p"' (deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 Q
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 Q
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures 3
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production O
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 1
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6 1
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 2
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 30
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 2/2/2016 Project/Site: TIP U-5760 Latitude: 36.128624
Stream SS
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115093
Kimley-Horn
Total Points: 35 Stream Determination (circle one) Other
Stream is at least intermittent Ephemeral Intermitte 2r2flflla .g. Quad Name: Be12WS Cf2ek
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 19 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 2
poolsequence
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 2
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or reater order channel No = 0 Yes = 3 3
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 2
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 1
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SS is a meandering perennial stream in a natural topographic
crenulation. The upper reach of SS has multiple headcuts with strong flow. The
stream goes underground in several locations.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
ry� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 02/02/2016
5. Name of stream: StC2at71 SS
7. Approximate drainage area: S9 aCl'eS
9. Length ofreach evaluated: 2,400 linear feet
11. Site coordinates (if known): prefer in decimal degrees.
Latituae �eX. 34.s�asia>: 36.128624
4. Time of evaluation: 1:00 pm
6. River basin: YaClkln
8. Stream order:, SeC011CI OI'Clef
10. County: F01"S�h
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i>: -80.115093
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated from its origin just south of NC 66 to its confluence with Kerners Mill Creek
14. Proposed channel work (if any): NOne
15. Recent weather conditions: Tf12 df ea I'2CeIVeCI 0.03" the day prior to the site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ 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
21. Estimated watershed land use: 60 % Residential _% Commercial _% Industrial _% Agricultural
40 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 3� 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: �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 warksheet. 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.
Total Score (from reverse): 58 Comments:
Stream SS is a meanderingperennial stream in a natural topographic crenulation. The upper reach of SS has multiple headcuts
with strong flow. The stream goes underground in several locations.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 02/02/2016
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 ratio or requirement. Form subject to change — version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SS
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 2
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 4
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 3
(deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands 3
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 2
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures 3
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5
�Root depth and density on banks
14 no visible roots = 0; dense roots throu hout = max oints 0— 3 0— 4 0— 5 �}
E�
� Impact by agriculture, livestock, or timber production 3
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 3
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity 3
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 3
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 1
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 3
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 58
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 2/2/2016 Project/Site: TIP U-5760 Latitude: 36.133520
Stream ST
EV81U8t01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115512
Kimley-Horn
Total Points: 31.5 Stream Determination � e Other
Stream is at least intermittent Ephemeral Intermitt nt Perennial e.g. Quad Name: Be12wS CI'2ek
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 17 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. n-c annel structure: ex. ri le-pool, step-poo ,
ripple-pool sequence 0 1 2 3 2
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 2
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1.5
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated; see discussions in manual
B. Hydrology Subtotal = g.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizin bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = 5
18. Fibrous roots in streambed 3 2 1 0 2
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream ST is a weak perennial channel fed by multiple groundwater
seeps. ST has moderate flow with shallow water over silt/sand that was likely
eroded from the surrounding hills. Drains to stream SS at a headcut.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 02/02/2016
5. Name of stream: StC2at71 ST
7. Approximate drainage area: 2 aCl"eS
9. Length ofreach evaluated: 92 Ilneal' f2et
11. Site coordinates (if known): prefer in decimal degrees.
Latituae �eX. 34.s�asia>: 36.133520
4. Time of evaluation: 2.30 pm
6. River basin: YaClkln
8. Stream order:, FII'St OI'der
10. County: F01"S�h
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i>: -80.115512
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated from its origin south of NC 66 to its confluence with stream SS
14. Proposed channel work (if any): NOne
15. Recent weather conditions: Tf12 df ea I'2CeIVeCI 0.03" the day prior to the site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? NO
21. Estimated watershed land use: 55 % Residential _% Commercial _% Industrial _% Agricultural
45 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 12� 23. Bank height (from bed to top of bank): 5�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 56 Comments:
Stream ST is a weak perennial channel fed by multiple groundwater seeps. ST has moderate flow with shallow water over
silt/sand that was likely eroded from the surrounding hills. Drains to stream SS at a headcut.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 02/02/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream ST
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 4
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 4
�, Presence of adjacent floodplain 1
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 2
p"' (deeply entrenched = 0; frequent flooding = max points)
g Presence of adjacent wetlands 0— 6 0— 4 0— 2 2
no wetlands = 0; lar e ad'acent wetlands = max oints
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 2
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures 3
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production 3
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 3
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity 3
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 5
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 56
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.133190
Stream SU
EV81U8t01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.115396
Kimley-Horn
Total Points: 2� Stream Determ' tion (circle one) Other
Stream is at least intermittent Ephemera ntermitte Perennial e.g. Quad Name: Be12wS CI'2ek
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 10.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 1
2. Sinuosity of channel along thalweg 0 1 2 3 2
. n-c anne structure: ex. ri le-pool, step-poo ,
ripple-pool sequence 0 1 2 3 2
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 0
8. Headcuts 0 1 2 3 1
9. Grade control 0 0.5 1 1.5 0
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated; see discussions in manual
B. Hydrology Subtotal = 7.5
12. Presence of Baseflow 0 1 2 3 2
13. Iron oxidizin bacteria 0 1 2 3 0
14. Leaf litter 1.5 1 0.5 0 0.5
15. Sediment on plants or debris 0 0.5 1 1.5 1
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal = 3
18. Fibrous roots in streambed 3 2 1 0 1
19. Rooted upland plants in streambed 3 2 1 0 2
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Crayfish 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SU is a weak intermittent stream that begins at a headcut
and drains to stream SS at a headcut. SU has low flow, but is in a washed
channel. SU goes underground before reaching SS. Channel bottom has good
substrate sorting. SU crosses a utility easement before the confluence with
SS and loses some bed/bank definition but the primary flow path and OHWM
are maintained.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET � ,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 02/02/2016
5. Name of stream: St1'2at11 SU
7. Approximate drainage area: 2 aCl"eS
9. Length ofreach evaluated: 131 IIIl2al' feet
11. Site coordinates (if known): prefer in decimal degrees.
Latitude �eX. 34.s�asia>: 36.133190
4. Time of evaluation: 3:00 pm
6. River basin: YaClkln
8. Stream order:, FII'St OI'der
10. County: F01"S�il
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i>: -80.115396
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated from its origin south of NC 66 to its confluence with stream SS
14. Proposed channel work (if any): NOne
15. Recent weather conditions: Ti12 df ea I'2CeIVeCI 0.03" the day prior to the site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters � Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 55 % Residential _% Commercial _% Industrial _% Agricultural
45 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 4� 23. Bank height (from bed to top of bank): 1�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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 scare of 100 representing a stream of the
highest quality.
Total Score (from reverse): 50 Comments:
Stream SU is a weak intermittent stream that begins at a headcut and drains to stream SS at a headcut. SU has low flow, but
is in a washed channel. SU goes underground before reaching SS. Channel bottom has good substrate sorting. SU crosses a
utility easement before the confluence with SS and loses some bed/bank definition but the primary flow path and OHWM are
maintained.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 02/02/2016
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 ratio or requirement. Form subject to change — version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SU
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 3
2 Evidence of past human alteration 0— 6 0— 5 0— 5 3
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain 1
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 2
p"' (deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 2
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 2
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 3
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures 3
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production 3
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 3
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity 3
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 4
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 50
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.124209
Stream SV
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.112811
Kimley-Horn
Total Points: 44 Stream Determination (cir Other Belews Creek &
Stream is at least intermittent Ephemeral Intermitten erennial e.g. Quad Name: KefllefSVllle
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 26.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 2
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 3
8. Headcuts 0 1 2 3 2
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1
11. Second or reater order channel No = 0 Yes = 3 3
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 11.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 1.5
16. Organic debris lines or piles 0 0.5 1 1.5 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SV is a perennial channel in a natural topographic valley. SV
begins at a stormwater pipe outlet and is severely incised at the top of reach
(-15'). The lower reaches are more stabilized, but there is significant sediment
deposition along the entire stream.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name• NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 02/02/2016
5. Name of stream: StC2at71 SV
4. Time of evaluation: 4:00 pm
6. River basin: YaClkln
7. Approximate drainage area: 6O aCl'eS 8. Stream order:, SeC011CI OI'Clef
9. Length ofreach evaluated: 1,990 linear feet 10. County: F01'S�il
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): N�A
Laritude �eX. 34.s�2312>: 36.124209 Longitude �eX. -��.ss66� �>: -80.112811
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated west of Hopkins Rd from pipe outlet north of Copperfield Ct to the confluence with Kerners Mill Creek
14. Proposed channel work (if any): NOne
15. Recent weather conditions: Tf12 df ea I'2CeIVeCI 0.03" the day prior to the site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:.
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 70 % Residential _% Commercial _% Industrial _% Agricultural
30 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 6-8� 23. Bank height (from bed to top of bank): 3-5�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 50 Comments:
Stream SV is a perennial channel in a natural topoaraphic valley. SV begins at a stormwater �ipe outlet and is severely incised
at the top of reach (�15'). The lower reaches are more stabilized, but there is significant sediment deposition along the entire
stream.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 02/02/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SV
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 2
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 3
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain 3
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 1
p"' (deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 1
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 Q
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 2
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production 3
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity 3
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 4
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 2
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 50
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 1/28/2016 Project/Site: TIP U-5760 Latitude: 36.123613
Stream SW
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.112908
Kimley-Horn
Total Points: 38.5 Stream Determination (cir Other
Stream is at least intermittent Ephemeral Intermitten erennial e.g. Quad Name: K2fflefSVlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 22.5 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 3
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 3
poolsequence
4. Particle size of stream substrate 0 1 2 3 3
5. Active/relic floodplain 0 1 2 3 1
6. Depositional bars or benches 0 1 2 3 3
7. Recent alluvial deposits 0 1 2 3 2
8. Headcuts 0 1 2 3 3
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 1
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 10
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 1
14. Leaf litter 1.5 1 0.5 0 1.5
15. Sediment on plants or debris 0 0.5 1 1.5 0.5
16. Organic debris lines or piles 0 0.5 1 1.5 1
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SW is a perennial channel that begins at a stormwater drop
inlet. Erosion/bank failures are present throughout the reach and severe
sediment build-up/deposition was observed within the reach.

USACE AID# DWQ # Site # (indicate on attached map)
� STREAM QUALITY ASSESSMENT WORKSHEET ��,�.,
�� �
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2. Evaluator's name: R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 02/02/2016 4. Time of evaluation: 4:45 pm
5. Name of stream: StC2at71 SW 6. River basin: YaClkln
7. Approximate drainage area: i2 aCreS 8. Stream order:, FII'St OI'der
9. Length ofreach evaluated: 3S2 IIIl2al' feet 10. County: F01'S�il
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): N�A
Laritude �eX. 34.s�2312>: 36.123613 Lon�itude �eX. -��.ss66i i�: -80.112908
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
The reach was evaluated between Hopkins Rd and Savannah Ct
14. Proposed channel work (if any): NOne
15. Recent weather conditions: Tf12 df ea I'2CeIVeCI 0.03" of rain the day prior to the site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from high-40s to mid-50s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: 60 % Residential _% Commercial _% Industrial _% Agricultural
40 % Farested _% Cleared / Logged _% Other ( )
22. Bankfull width: 4� 23. Bank height (from bed to top of bank): 2�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 49 Comments:
Stream SW is a perennial channel that begins at a stormwater drop inlet. Erosion/bank failures are present throughout the
reach and severe sediment build-up/deposition was observed within the reach.
Evaluator's Signature `�`9'�'' `�`'`'�`'`�`a"'' Date 02/02/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SW
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 3
2 Evidence of past human alteration 0— 6 0— 5 0— 5 3
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 �}
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 3
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 3
�, Presence of adjacent floodplain 1
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
�; � Entrenchment / floodplain access 0— 5 0— 4 0— 2 2
p"' (deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 3
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 1
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 2
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5 2
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5 2
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 4
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity 3
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 4
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 2
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 49
* These characteristics are not assessed in coastal streams.

North Carolina Division of Water Quality - Stream Identification Form, Version 4.11
Date: 2/8/2016 Project/Site: TIP U-5760 Latitude: 36.109392
Stream SX
EV81Uat01': R. Sullivan/J. Hartshorn County: Forsyth Longitude: -80.090296
Kimley-Horn
Total Points: 25.5 Stream Deter ' ' (circle one) Other
Stream is at least intermittent Ephemera ntermitten erennial e.g. Quad Name: K2fflefSVlll2
if >_ 19 or perennial if >_ 30
A. Geomorphology Subtotal = 9 Absent Weak Moderate Strong Score
1a. Continuity of channel bed and bank 0 1 2 3 3
2. Sinuosity of channel along thalweg 0 1 2 3 0
3. In-channel structure: ex. riffle-pool, step-pool, ripple- 0 1 2 3 1
poolsequence
4. Particle size of stream substrate 0 1 2 3 2
5. Active/relic floodplain 0 1 2 3 0
6. Depositional bars or benches 0 1 2 3 1
7. Recent alluvial deposits 0 1 2 3 1
8. Headcuts 0 1 2 3 0
9. Grade control 0 0.5 1 1.5 0.5
10. Natural valley 0 0.5 1 1.5 0.5
11. Second or reater order channel No = 0 Yes = 3 0
artificial ditches are not rated: see discussions in manual
B. Hydrology Subtotal = 10.5
12. Presence of Baseflow 0 1 2 3 3
13. Iron oxidizing bacteria 0 1 2 3 3
14. Leaf litter 1.5 1 0.5 0 1
15. Sediment on plants or debris 0 0.5 1 1.5 0
16. Organic debris lines or piles 0 0.5 1 1.5 0.5
17. Soil-based evidence of high water table? No = 0 Yes = 3 3
C. Biology Subtotal =
18. Fibrous roots in streambed 3 2 1 0 3
19. Rooted upland plants in streambed 3 2 1 0 3
20. Macrobenthos (note diversity and abundance) 0 1 2 3 0
21. Aquatic Mollusks 0 1 2 3 0
22. Fish 0 0.5 1 1.5 0
23. Cra�sh 0 0.5 1 1.5 0
24. Amphibians 0 0.5 1 1.5 0
25. Algae 0 0.5 1 1.5 0
26. Wetland plants in streambed FACW = 0.75; OBL = 1.5; Other = 0 0
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: Stream SX is an intermittent stream channel that is mostly piped and
only daylights within the project corridor for - 47'. The channel is linear. There
was strong flow during the site visit.

USACE AID# DWQ # Site # (indicate on attached map)
;,�,; STREAM QUALITY ASSESSMENT WORKSHEET �� �,�
Provide the following information for the stream reach under assessment: �,
1. Applicant's name: NCDOT 2 Evaluator's name• R. SUIIIVaCl/J. Hartshorn (Kimley-Horn)
3. Date of evaluation: 02/O8/2016
5. Name of stream: StC2at71 SX
7. Approximate drainage area: 32 aCl'eS
9. Length ofreach evaluated: 4J Ilneal' f2et
11. Site coordinates (if known): prefer in decimal degrees.
Latitude �eX. 34.s�asia>: 36.109392
4. Time of evaluation: 5:30 pm
6. River basin: YaClkln
8. Stream order:, FII'St OI'der
10. County: F01"S�h
12. Subdivision name (if any): N�A
Lon�itude �eX. -��.ss66i i�: -80.090296
Method location determined (circle): �PS�✓ I'opo Shee ✓t�Jrtho (Aerial) Photo/GIS�ther GIS❑�ther
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
Stream SX daylights in the corridor for 47' just south of Business I 40 and north of Arbor Hill Rd
14. Proposed channel work (if any): NOne
15. Re�ent Weatner �ona�t�ons: Mostly sunny and cool with no rain within 48 hours prior to site visit
16. s�te �ona�nons at t�me of�s�t: Partly cloudy with temps ranging from low-30s to high-40s (Fahrenheit)
17. Identify any special waterway classificaYions known: ,�Section 10 �Tidal Waters �Essential Fisheries Habitat
nTrout Waters �Outstanding Resource Waters ,� Nutrient Sensitive Waters nWater Supply Watershed II I (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? NQ If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? NQ 20. Does channel appear on USDA Soil Survey? YES
21. Estimated watershed land use: _% Residential 85 % Commercial _% Industrial _% Agricultural
5% Farested _% Cleared / Logged 10 °ro otner � Paved Road �
22. Bankfull width: 10� 23. Bank height (from bed to top of bank): 4�
24. Channel slope down center of stream: �Flat (0 to 2%) �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 range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the warksheet. 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.
Total Score (from reverse): 25 Comments:
Stream SX is an intermittent stream channel that is mostl�piped and only da�4hts within the project corridor for � 47'. The
Evaluator's Signature `�`9 �'' `�`'`'�`'`�`a"'' Date 02/08/2016
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 ratio or requirement. Form subject to change - version 06/03. To Comment, please ca11919-876-8441 x 26.

Stream SX
STREAM QUALITY ASSESSMENT WORKSHEET
ECORE ION POINT RANGE
# CHARACTERISTICS Coastal Piedmont Mountain SCORE
Presence of flow / persistent pools in stream
1 (no flow or saturation = 0; strong flow = max points) 0— 5 0— 4 0— 5 �}
2 Evidence of past human alteration 0— 6 0— 5 0— 5 �
extensive alteration = 0; no alteration = maac oints
3 Riparian zone 0— 6 0— 4 0— 5 Q
no buffer = 0• conti ous wide buffer = max oints
4 Evidence of nutrient or chemical discharges 0— 5 0— 4 0— 4 2
(extensive discharges = 0; no discharges = m� points)
a Groundwater discharge
v5 no discharge = 0; sprin s, seeps, wetlands, etc. = max points) 0— 3 0— 4 0— 4 2
�, Presence of adjacent floodplain O
y 6 (no floodplain = 0; extensive floodplain = max oints) 0— 4 0— 4 0— 2
a� Entrenchment / floodplain access 0— 5 0— 4 0— 2 Q
(deeply entrenched = 0; frequent flooding = max points)
Presence of adjacent wetlands O
g no wetlands = 0; lar e ad'acent wetlands = max oints 0— 6 0— 4 0— 2
9 Channel sinuosity 0— 5 0— 4 0— 3 Q
extensive channelization = 0; natural meander = max oints
10 Sediment input 0— 5 0— 4 0— 4 1
(extensive deposition= 0; little or no sediment = max points)
11 Size & diversity of channel bed substrate NA* 0— 4 0— 5 3
fine, homo enous = 0; lar e, diverse sizes = max points
12 Evidence of channel incision or widening 0— 5 0— 4 0— 5 1
�+ (deeply incised = 0; stable bed & banks = max points)
�.F''., Presence of major bank failures 3
� 13 (severe erosion = 0; no erosion, stable banks = max points) 0— 5 0— 5 0— 5
� 14 Root depth and density on banks 0— 3 0— 4 0— 5 3
F., no visible roots = 0; dense roots throu hout = max oints
� Impact by agriculture, livestock, or timber production O
15 substantial im act =0; no evidence = max oints 0— 5 0— 4 0— 5
16 Presence of riffle-pooUripple-pool complexes 0— 3 0— 5 0— 6 1
� no riffles/ri les ar ools = 0; well-develo ed = max oints
� Habitat complexity O
� 1� (little or no habitat = 0; frequent, varied habitats = max points) 0— 6 0— 6 0— 6
� 1 g Canopy coverage over streambed 0— 5 0— 5 0— 5 2
,�, no shadin ve etation = 0; continuous cano = max oints
19 Substrate embeddedness NA* 0— 4 0— 4 3
dee 1 embedded = 0; loose structure = max
20 Presence of stream invertebrates (see page 4) 0— 4 0— 5 0— 5 Q
�„� (no evidence = 0; common, numerous types = max points)
� 21 Presence of amphibians 0— 4 0— 4 0— 4 Q
� no evidence = 0; common, numerous types = max points)
� 22 Presence of fish 0— 4 0— 4 0— 4 Q
� (no evidence = 0; common, numerous rypes = max points)
23 Evidence of wildlife use 0— 6 0— 5 0— 5 Q
(no evidence = 0; abundant evidence = max points)
Total Points Possible 100 100 100
TOTAL SCORE (also enter on iirst page) 25
* These characteristics are not assessed in coastal streams.

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�26�2016
ApplicanUOwner: NCDOT State: NC Sampling Point: WA-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Levee Local relief (concave, convex, none): C011V2X Slope (%): � 1%
Subregion (LRR or MLRA): LRR P �at: 36.107350 Long: -$0.106666 Datum: NAD 83
soii nnap unit rvame: Dan River loam NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ No
✓ Is the Sampled Area /
Hydric Soil Present? Yes No within a Wetland? Yes No �
Wetland Hydrology Present? Yes No ✓
Remarks:
WA-UP is located N45' south of and 1' higher in elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reouired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 3��� �
Saturation Present? Yes � No n Depth (inches): >3��� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer negundo 25% Y FAC
2. Sycamore occidentalis 15% Y FACW
g. Acer rubrum 5% N FAC
4.
5.
6.
7.
8.
45% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Acer negundo 20% Y FAC
2. Prunus serotina 10% Y FACU
3. Ligustrum sinense 10% Y FACU
4, Rosa multiflora 5% N FACU
5. Juniperus virginiana 5% N
6.
7.
8.
9.
10.
50% = Total Cover
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum 40% Y FAC
Z. Rubus argutus 20% Y FACU
3, Allium canadense 10% N FACU
4.
5.
7.
8.
9.
10.
11
12
Sampling Point: WA-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 5 (A)
Total Number of Dominant
Species Across All Strata: 9 (B)
Percent of Dominant Species 55.fi%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
_ 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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
70% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Lonicera_japonica 10% Y FAC hei ht.
2.Hedera helix 1°/ Y FACU
3.
4.
5.
6.
2�% = Total Cover
Hydrophytic
Vegetation
Present? Yes � No
Remarks: (Include photo numbers here or on a separate sheet.)
The data point was taken on the edge of easement on landward side of the stream levee.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WA-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 (moistl % Tvpe' Loc2 Texture Remarks
0-3" 7.5YR 2.5/3 100% Loam
3-20" 7.5YR 4/4 100% Loam
20-30" 7.5YR 4/4 100% Loamy clay
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
No indicators of wetland soil observed at the upland data point.
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760
ApplicanUOwner: NCDOT
cityicounty: Kernersville/Forsyth Sampling Date: 1�26�2016
State: NC Sampling Point: WA-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, et�.�: Stream floodplain Local relief (concave, convex, none): NOne Slope (%): � 1%
Subregion (LRR or MLRA): LRR P �at: 36.107477 �ong: -80.106633 Datum: NAD 83
soii nnap unit rvame: Dan River loam NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetland WA is a stream floodplain wetland adjacent to Smith Creek. WA is partially within a maintained
sewer/stormwater easement and is supported hydrologically by seepage from upslope stormwater pond.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) ✓ Drainage Patterns (B10)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) ✓ Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) ✓ Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
✓ Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
��
Surface Water Present? Yes ✓ No Depth (inches): �-6
Water Table Present? Yes ✓ No Depth (inches): $UI'faCe
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
Saturated soils and the water table were both observed at the surface. Dense algae was observed
in pools of standing water. The area is likely frequently flooded and receives seepage from adjacent
hillslope and stormwater pond.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. None
2.
3.
4.
5.
6.
7.
8.
= Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Acer rubrum 5% Y FAC
2. Liquidambar styrac�ua 5% Y FAC
3. Fraxinus pennsylvanica 5% Y FACW
4.
5.
6.
7.
8.
9.
10.
15% = Total Cover
Herb Stratum (Plot size: 15� )
�. Festuca sp. 40% Y FACU
Z, Juncus effusus 20% Y FACW
3, Cyperus strigosus 20% Y FACW
4, Solidago sp. 5% N NI
5. Rubus argutus 5% N FACU
7.
8.
9.
10.
11
12
Sampling Point: WA-WET
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 6 (A)
Total Number of Dominant
Species Across All Strata: � (B)
Percent of Dominant Species 85 �a�o
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
_ 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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
90% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Lonicera_japonica 10% Y FAC hei ht.
2.
3.
4.
5.
6.
1�% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The data point is in a frequently maintained utility easement.
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WA-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 (moistl % Tvpe' Loc2 Texture Remarks
0-7" 10YR 5/2 85% 7.5YR 5/6 15% C M Sandy clay
7-14" 10YR 3/1 90% 10YR 5/6 10% C M Clay gravelly
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
The water table and soil saturation was present at the surface. Below 14" the soils were too
rocky/packed for removal/analysis.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�26�2016
ApplicanUOwner: NCDOT State: NC Sampling Point: WB-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, et�.�: Stream levee Local relief (concave, convex, none): C011V2X Slope (%): � 1%
Subregion (LRR or MLRA): LRR P �at: 36.110878 �ong: -80.113323 Datum: NAD 83
Soil Map Unit Name: Hdtb01'0 IOd111 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes No ✓
Yes No ✓
WB-UP is a natural levee between WB and SE.
HYDROLOGY
Is the Sampled Area /
within a Wetland? Yes No �
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reouired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 3��� �
Saturation Present? Yes � No n Depth (inches): 3��� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Fagus grandifolia 30% Y FACU
z. Acer rubrum 30% Y FAC
g. Liquidambar styraciflua 30% Y FAC
4. Fraxinus pennsylvanica 10% N FACW
5.
6.
7.
8.
1��% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Quercus phellos 5% Y
2. Juniperus virginiana 5% Y
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum
Z. Andropogon virginicus
3.
4.
5.
7.
8.
9.
10.
11
12
10% = Total Cover
60% Y
30% Y
Sampling Point: WB-�P
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 5 (A)
Total Number of Dominant
Species Across All Strata: 8 (B)
Percent of Dominant Species C2.5%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC FAC species x 3=
FACU FACU species x 4=
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
FAC Problematic Hydrophytic Vegetation' (Explain)
FACU
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Veaetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
90% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Lonicera_japonica 5% Y FAC hei ht.
2.
3.
4.
5.
6.
5% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WB'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 (moistl % Tvpe' Loc2 Texture Remarks
0-14" 10YR 4/3 100% Loam
14-30" 10YR 4/4 100% Sandy loam
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surtace (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
No hyrdric soil indicators present at the upland data point. The sand increases with depth. Neither
the water table nor soil saturation was observed within 30".
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�26�2016
ApplicanUOwner: NCDOT State: NC Sampling Point: WB-W�
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Bottomland Local relief (concave, convex, none): COnCdVe Slope (%): � 1%
Subregion (LRR or MLRA): LRR P �at: 36.110860 �ong: -80.113372 Datum: NAD 83
Soil Map Unit Name: Hdtb01'0 IOd111 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetland WB is a bottomland wetland associated with Smith Creek. The wetland also appears to
receive seepage from adjacent fishery ponds.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) ✓ Drainage Patterns (B10)
✓ Saturation (A3) �/ Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) ✓ Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) ✓ Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
�� ��
Surface Water Present? Yes ✓ No Depth (inches): 1-4
Water Table Present? Yes No ✓ Depth (inches): >3���
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
WB receives hydrology from water seeping through the adjacent fishery pond berms and whenever
Smith Creek floods. Standing water was observed throughout the wetland, however the wetland
data point was taken on a slight hummock.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Salix nigra 15% Y OBL
z. Acer rubrum 10% Y FAC
3.
4.
5.
6.
7.
8.
25% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Alnus serrulata 20% Y OBL
2. Acer rubrum 20% Y FAC
3. Fraxinus pennsylvanica 10% N FACW
4, Liguidambar styraciflua 5% N FAC
5. Salix nigra 5% N OBL
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum
Z, Juncus effusus
3.
4.
5.
7.
8.
9.
10.
11.
12.
Woodv Vine Stratum (Plot size: 3�� )
� .None
2.
3.
4.
5.
6.
60% = Total Cover
70% Y FAC
15% N FACW
85% = Total Cover
= Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Sampling Point: WB-W�
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 5 (A)
Total Number of Dominant
Species Across All Strata: 5 (B)
Percent of Dominant Species 100%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
_ 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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody vine - All woody vines greater than 3.28 ft in
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Sampling Point: WB-W�
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2 Texture Remarks
0-10" 7.5YR 6/1 60% 7.5YR 5/6 40% C PL Sandy clay
10-15" 7.5YR 5/2 70% 5YR 5/4 30% C M Loamy sand
15-30" 7.5YR 5/1 60% 7.5YR 4/6 40% C PL Clay
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
The soil is saturated at the surface. The soil had a depleted matrix.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�27�2016
ApplicanUOwner: NCDOT State: NC Sampling Point: WD-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.): HIIISIOp2 Local relief (concave, convex, none): NOne Slope (%): 4-6%
Subregion (LRR or MLRA): LRR P �at: 36.111523 �ong: -80.113006 Datum: NAD 83
Soil Map Unit Name: Hdtb01'0 IOd111 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes No ✓
Yes No ✓
Is the Sampled Area /
within a Wetland? Yes No �
WD-UP is on a hillslope above wetland WD. The upland data point is 15' east of and 3' higher in
elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 3��� �
Saturation Present? Yes � No n Depth (inches): >30�� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No wetland hydrology indicators observed at the upland data point. Groundwater appears to move
through the soil profile above a restrictive layer at 7", but not a sufficient duration to create a
hydrology indicator.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Liriodendron tulipifera 30% Y FACU
z. Acer rubrum 30% Y FAC
g. Platanus occidentalis 30% Y FACW
4. Liquidambar styraciflua 10% N FAC
5.
6.
7.
8.
1��% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Acer rubrum 20% Y FAC
2. Liriodendron tulipifera 15% Y FACU
3. Fraxinus pennsylvanica 10% N FACW
4, Liguidambar styraciflua 10% N FAC
5. Rosa multiflora 5% N FACU
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Rubus argutus
2.
3.
4.
5.
7.
8.
9.
10.
11
12
Sampling Point: WD-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 6 (A)
Total Number of Dominant
Species Across All Strata: 8 (B)
Percent of Dominant Species 75a�o
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
60% = Total Cover -
data in Remarks or on a separate sheet)
5% Y FAC _ 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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
5% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Lonicera_japonica 5% Y FAC hei ht.
2. Vitis rotundifolia 5% Y FAC
3.
4.
5.
6.
1�% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-4" 7.5YR 3/3 100%
4-7" 7.5YR 3/1 85% 7.5YR 5/6 15% C M
7-20" 10YR 5/2 85% 7.5YR 5/6 15% C M
20-30" 7.5YR 6/5 100%
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surtace (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Sampling Point: WD-UP
Texture Remarks
Loam
Loam
Loamy clay
Loamy clay
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
8 Umbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
Soil has a tight clay layer at 7" that is holding water close to the surface when it seeps down the
hillslope creating concentrations. However, no concentrations were observed along the pore linings
and the soils were bright above and below the restrictive layer.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�27�2016
ApplicanUOwner: NCDOT State: NC Sampling Point: W�'W�
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, et�.�: Bottomland floodplain Local relief (concave, convex, none): NOne Slope (%): 1%
Subregion (LRR or MLRA): LRR P �at: 36.111527 �ong: -80.113057 Datum: NAD 83
Soil Map Unit Name: Hdtb01'0 IOd111 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetland WD is a bottomland wetland that ponds stormwater and floods with Smith Creek. Surface water
was observed in the wetland to a depth of 6", and a ditch has been cut along the boundary near Smith
Creek.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
✓ Saturation (A3) �/ Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) ✓ Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) ✓ Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
��
Surface Water Present? Yes ✓ No Depth (inches): �-6
Water Table Present? Yes ✓ No Depth (inches): $UI'faCe
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
WD-WET is on a very slight hillslope on the eastern edge of wetland WD. The wetland ponds water
from precipitation and flooding from Smith Creek.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) — Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer rubrum 60% Y FAC
z. Liriodendron tulipifera 15% N FACU
g. Platanus occidentalis 10% N FACW
4.
5.
6.
7.
8.
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Rosa multiflora
2. Liquidambar styrac�ua
� Acer rubrum
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum
2.
3.
4.
5.
7.
8.
9.
10.
11
12
85% = Total Cover
Sampling Point: W�-W�
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 6 (A)
Total Number of Dominant
Species Across All Strata: � (B)
Percent of Dominant Species 85 �a�o
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
10% Y FACU FAC species x 3=
5% Y FAC FACU species x 4=
5% Y FAC UPL species x 5=
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
ZD% = Total Cover —
data in Remarks or on a separate sheet)
3�% Y FAC _ 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.
Sapiing/Shrub – Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb – All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
30% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine – All woody vines greater than 3.28 ft in
�.Lonicera_japonica 5% Y FAC hei ht.
2.Smilaz rotundifolia 5% Y FAC
3.
4.
5 Hydrophytic
Vegetation
6• Present? Yes � No
1�% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Light understory observed within the wetland. Vegetation was concentrated on hummocks within the wetland.
US Army Corps of Engineers Eastern Mountains and Piedmont – Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Sampling Point: W�-W�
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2 Texture Remarks
0-3" 10YR 4/1 90% 10YR 3/4 10% C M Loamy clay
3-20" 10YR 6/2 90% 7.5YR 5/6 10% C M Sandy clay
20-30" 10YR 5/1 95% 10YR 5/6 5% C M Sandy clay loam
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surtace (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
8 Umbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
Both saturation and the water table was observed at the surface. No surface water observed at the
data point but was observed throughout much of the wetland's interior.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760
ApplicanUOwner: NCDOT
cityicounty: Kernersville/Forsyth Sampling Date: 1�2H�2O16
State: NC Sampling Point: WE-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.): HIIISIOp2 Local relief (concave, convex, none): C011V2X Slope (%): 5%
Subregion (LRR or MLRA): LRR P �at: 36.113924 Long: -$0.124960 Datum: NAD 83
so�i nnap ur,�t rvame: Fairview fine sandy loam NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes No ✓
Yes No ✓
Yes No ✓
Is the Sampled Area /
within a Wetland? Yes No �
WE-UP is approximately 40' east of and 3' higher in elevation than the wetland data point location
and is situated on a hillslope.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reouired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 3��� �
Saturation Present? Yes � No n Depth (inches): >3��� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Liriodendron tulipifera 35% Y FACU
z. Quercus alba 25% Y FACU
3. Oxydendrum arboreum 15% N UPL
4, Carya tomentosa 15% N UPL
5.
6.
7.
8.
Saalinp/Shrub Stratum (Plot size: 3�� )
�. Carya tomentosa
2. Carpinus caroliniana
� Cornus florida
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. None
2.
3.
4.
5.
7.
8.
9.
10.
11
12
90% = Total Cover
Sampling Point: WE-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 3 (A)
Total Number of Dominant
Species Across All Strata: � (B)
Percent of Dominant Species 42 9%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
10% Y UPL FAC species 15 x 3= 45
5% Y FAC F,4Cu species 65 x 4= 260
5% Y FACU UPL species 40 x 5= 200
Co�umn Tota�s: 120 (,4) 505 (a)
Prevalence Index = B/A = 4.2
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
2 - Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
ZD% = Total Cover -
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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
= Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
1.Smilax rotundifolia 5% Y FAC hei ht.
2.Lonicera iaponica 5% Y FAC
3.
4.
5.
6.
1�% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic �
Vegetation
Present? Yes No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WE-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 (moistl % Tvpe' Loc2 Texture Remarks
0-4" 10YR 3/3 100% Loam
4-24" 10YR 4/6 100% Clay loam
24-30" 7.5YR 5/6 100% Clay
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
No hydric soil indicators were observed at the upland data point.
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�2H�2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: WE-W�
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, et�.�: Depressional wetland Local relief (concave, convex, none): COnCdVe Slope (%): 1-2%
Subregion (LRR or MLRA): LRR P �at: 36.113970 �ong: -80.125040 Datum: NAD 83
so�i nnap ur,�t rvame: Fairview fine sandy loam NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetland WE is a depressional wetland that was previously connected to a large fish hatchery pond by a
buried pipe. WE appears to have been historically dugout, with one of the side slopes having partially
buried trash and appears to have been used as a trash dump historically.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) ✓ Drainage Patterns (B10)
✓ Saturation (A3) �/ Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
✓ Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) ✓ Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
✓ Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes ✓ No Depth (inches): 1'2
��
Water Table Present? Yes ✓ No Depth (inches): 2��
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
Hydrology is primarily from groundwater and overland flow during precipitation events. Standing
water was observed in the wetland to a depth of 2".
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer rubrum 30% Y FAC
z. Fraxinus pennsylvanica 25% Y FACW
3. Carpinus caroliniana 10% N FAC
4.
5.
6.
7.
8.
65% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Viburnum dentatum 15% Y FAC
2. Acer rubrum 10% Y FAC
3. Carpinus caroliniana 5% Y FAC
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum
Z, Carex sp.
3.
4.
5.
7.
8.
9.
10.
11
12
30% = Total Cover
30% Y
15% Y
Sampling Point: WE-W�
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 9 (A)
Total Number of Dominant
Species Across All Strata: 9 (B)
Percent of Dominant Species 100%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
FAC Problematic Hydrophytic Vegetation' (Explain)
FAC
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Veaetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
45% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Lonicera_japonica 5% Y FAC hei ht.
2.Smilaz rotundifolia 5% Y FAC
3.
4.
5.
6.
1�% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WE-W�
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 (moistl % Tvpe' Loc2 Texture Remarks
0-2" 10YR 2/2 100% Loam
2-14" 2.5Y 6/2 95% 7.5YR 4/4 5% C PL Sandy loam
14-30" 7.5YR 5/6 90% 10YR 6/2 10% D M Clay
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
✓ Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
✓ Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
The soil was saturated at the surface with the water table beginning at N 1-2".
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�2H�2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: WF-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Bottomland Local relief (concave, convex, none): COnCdVe Slope (%): 1%
Subregion (LRR or MLRA): LRR P �at: 36.125470 Long: -$0.112010 Datum: NAD 83
Soil Map Unit Name: Fall'VIeW CIdY IOdl11 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes No ✓
Yes No ✓
Is the Sampled Area /
within a Wetland? Yes No �
WF-UP is in a bottomland that has been altered by ditching to carry drainage away from a
pool/recreational field positioned below a large pond. The upland data point is N15' west of and 1' higher
in elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Present? Yes � No I v I Depth (inches):
Water Table Present? Yes ✓ No II Depth (inches): 14�� �
Saturation Present? Yes � No n Depth (inches): 14�� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point. Seasonal high water
table was observed at 14".
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Liriodendron tulipifera 40% Y FACU
z. Acer rubrum 20% Y FAC
g. Pinus virginiana 20% Y NI
4.
5.
6.
7.
8.
$�% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Ilex vomitoria 20% Y FAC
2. Juniperus virginiana 5% Y FACU
3. Liquidambar styraciflua 5% Y FAC
4, Acer rubrum 5% Y FAC
5. Ilex opaca 5% Y FACU
g. Rosa multiflora 5% Y FACU
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. None
2.
3.
4.
5.
7.
8.
9.
10.
11
12
Sampling Point: WF-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 5 (A)
Total Number of Dominant
Species Across All Strata: 9 (B)
Percent of Dominant Species 55.fi%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
45% = Total Cover -
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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
= Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
1. Vitis rotundifolia 5% Y FAC hei ht.
2.
3.
4.
5.
6.
5% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WF-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 (moistl % Tvpe' Loc2 Texture Remarks
0-14" 2.5Y 5/6 100% Sandy clay
14-24" 10YR 6/6 90% 10YR 7/1 10% D M Sandy clay
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surtace (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
8 Umbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
The soil was a tight clay and could not auger below 24". Neither saturation or the water table was
observed within 24" of the soil profile. Depletions increased with depth.
No indicators of hydric soil was observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�2H�2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: WF-W�
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Bottomland Local relief (concave, convex, none): COnCdVe Slope (%): 1%
Subregion (LRR or MLRA): LRR P �at: 36.125468 �ong: -80.111987 Datum: NAD 83
Soil Map Unit Name: Fall'VIeW CIdY IOdl11 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetland WF is a bottomland wetland below a large pond. Stream SN runs along the outer edge of WF. It
appears that SN has been historically ditched, likely to direct water/seepage away from adjacent
pool/recreational area.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) ✓ Drainage Patterns (B10)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) ✓ Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
✓ Iron Deposits (B5) ✓ Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
✓ Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
��
Surface Water Present? Yes ✓ No Depth (inches): �'2
Water Table Present? Yes ✓ No Depth (inches): $UI'faCe
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
WF-WET is within a low drainage pattern in WF. Iron oxidizing bacteria and iron deposits are
present throughout the wetland and surface water. The primary wetland hydrology inputs appear to
be from groundwater seepage from the upslope pond.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Liriodendron tulipifera 10% Y FACU
z. Liguidambar styraciflua 10% Y FAC
g. Acer rubrum 10% Y FAC
4.
5.
6.
7.
8.
30% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Ilex vomitoria 25% Y
2. Rosa multiflora 15% Y
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. None
2.
3.
4.
5.
7.
8.
9.
10.
11.
12.
Woodv Vine Stratum (Plot size: 3�� )
� .None
2.
3.
4.
5.
6.
Sampling Point: WF-W�
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 3 (A)
Total Number of Dominant
Species Across All Strata: 5 (B)
Percent of Dominant Species 6�%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC FAC species x 3=
FACU FACU species x 4=
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
40% = Total Cover -
data in Remarks or on a separate sheet)
_ Problematic Hydrophytic Vegetation' (Explain)
= Total Cover
= Total Cover
'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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody vine - All woody vines greater than 3.28 ft in
Hydrophytic
Vegetation
Present? Yes � No
Remarks: (Include photo numbers here or on a separate sheet.)
Yaupon holly dominates the wetland area. It was likely planted as an ornamental and has naturalized in the natural
areas. Sparse vegetation was observed within much of the inundated portions of the wetland.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WF-W�
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 (moistl % Tvpe' Loc2 Texture Remarks
0-3" 2.5Y 5/2 100% Loam
3-8" 2.5Y 6/1 70% 2.5Y 6/6 30% C M Clay
8-24" 2.5Y 6/1 85% 2.5Y 6/6 15% C M Clay loam
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
The water table and soil saturation was observed at the surface.
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�2H�2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: WG/WH-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.): HIIISIOp2 Local relief (concave, convex, none): NOne Slope (%): 1-2%
Subregion (LRR or MLRA): LRR P �at: 36.134305 Long: -$0.122574 Datum: NAD 83
soii nnap unit rvame: Nathalie sandy loam NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes No ✓
Yes No ✓
Yes No ✓
Is the Sampled Area /
within a Wetland? Yes No �
The upland data point is N30' west of and 0.5' higher in elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reouired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 3��� �
Saturation Present? Yes � No n Depth (inches): >3��� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer rubrum 25% Y FAC
2.
3.
4.
5.
6.
7.
8.
25% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, LiQustrum sinense 15%
2.
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Digitaria sanguinalis
Z. Allium canadensis
3.
4.
5.
7.
8.
9.
10.
11
12
Sampling Point: WG/WH-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 2 (A)
Total Number of Dominant
Species Across All Strata: 4 (B)
Percent of Dominant Species 5�%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
Y FACU FAC species 35% x 3= 105
FACU species 70% x 4= 280
UPL species x 5 =
Co�umn Tota�s: 105 (,4) 385 (a)
15% = Total Cover
50% Y
5% N
Prevalence Index = B/A = 3.67
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
2 - Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
FACU Problematic Hydrophytic Vegetation' (Explain)
FACU
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Veaetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 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% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Toxicodendron radicans 10% Y FAC hei ht.
2.
3.
4.
5.
6.
1�% = Total Cover
Hydrophytic �
Vegetation
Present? Yes No
Remarks: (Include photo numbers here or on a separate sheet.)
The upland area lacks the wetland vegetation that is present in the seep areas.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Sampling Point: WG/WH-UP
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2 Texture Remarks
0-30" 7.5YR 4/6 100% Sandy clay loam
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
No hydric soil indicators were observed at the upland data point.
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 1�2H�2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: WG�WH-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Hillslope seep Local relief (concave, convex, none): NOne Slope (%): 2%
Subregion (LRR or MLRA): LRR P �at: 36.134315 �ong: -80.122465 Datum: NAD 83
soii nnap unit rvame: Nathalie sandy loam NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetlands WG and WH are seep wetlands on each side of stream SP. There are several large truck "wash
bays" and associated water retention ponds that slowly seep water downslope to the wetlands and
stream.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
✓ Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
��
Surface Water Present? Yes ✓ No Depth (inches): 1
Water Table Present? Yes ✓ No Depth (inches): $UI'faCe
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
The water table and soil saturation was observed at the surFace. The hillside seeps are primarily fed
hydrology from active truck washing stations upslope at concrete plant. Iron oxidizing bacteria was
observed in the wetlands. Stream SP is incised N4' below the wetlands.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer rubrum 30% Y FAC
z. Liguidambar styraciflua 25% Y FAC
3.
4.
5.
6.
7.
8.
55% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
� , None
2.
4.
5.
6.
7.
8.
9.
10.
= Total Cover
Herb Stratum (Plot size: 15� )
�. Digitaria sanguinalis 45% Y FACU
Z, Carex sp. 20% Y FAC
3, Juncus effusus 20% Y FACW
4.
5.
7.
8.
9.
10.
11.
12.
85% = Total Cover
Woodv Vine Stratum (Plot size: 3�� )
� .None
2.
3.
4.
5.
6.
= Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Sampling Point: WG/WH-WET
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 4 (A)
Total Number of Dominant
Species Across All Strata: 5 (B)
Percent of Dominant Species $�a�o
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
_ 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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody vine - All woody vines greater than 3.28 ft in
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-5" 10YR 3/1 100%
5-15" 10YR 4/1 95% 7.5YR 3/4 5% C M
15-25" 10YR 5/1 70% 10YR 6/8 30% C M
25-30" 10YR 4/1 98% 10YR 6/6 2% C M
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
✓ Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Sampling Point: WG�WH-W�
Texture Remarks
Sandy loam
Sandy loam
Sandy clay
Cla�
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
The water table and soil saturation was observed at the soil surface.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760
ApplicanUOwner: NCDOT
cityicounty: Kernersville/Forsyth Sampling Date: 2�2I2O16
State: NC Sampling Point: WI/WJ-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Levee Local relief (concave, convex, none): C011V2X Slope (%): 1%
Subregion (LRR or MLRA): LRR P �at: 36.127164 Long: -$0.112865 Datum: NAD 83
Soil Map Unit Name: Hdtb01'0 IOd111 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes No ✓
Yes No ✓
Is the Sampled Area /
within a Wetland? Yes No �
WI/WJ-UP is on a natural levee between Kerners Mill Creek and the wetlands. The creek appears to flood
regularly. The upland data point is N33' northwest of and 1' higher in elevation than the wetland data
point location.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reouired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 3��� �
Saturation Present? Yes � No n Depth (inches): >3��� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer rubrum 40% Y FAC
z. Liguidambar styraciflua 15% Y FAC
3.
4.
5.
6.
7.
8.
55% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Rosa multiflora 10% Y FACU
2. Ligustrum sinense 10% Y FACU
3. Nandina domestica 5% N NI
4. Fagus grandifolia 5% N FACU
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum
Z. Allium canadense
3.
4.
5.
7.
8.
9.
10.
11
12
30% = Total Cover
30% Y
10% Y
Sampling Point: WI/WJ-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 5 (A)
Total Number of Dominant
Species Across All Strata: 8 (B)
Percent of Dominant Species C2.5%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
FAC Problematic Hydrophytic Vegetation' (Explain)
FACU
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Veaetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
40% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Lonicera_japonica 10% Y FAC hei ht.
2. Vitis rotundifolia 1°/ Y FAC
3.
4.
5.
6.
2�% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The upland data point was taken on a creek levee.
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-2" 10YR 3/3 100%
2-15" 7.5YR 4/4 100%
15-24" 10YR 5/3 80% 7.5YR 5/4 20% C M
24-30" 7.5YR 5/1 60% 7.5YR 4/5 40% C M
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surtace (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Sampling Point: WI/WJ-UP
Texture Remarks
Loam
Loam
Loamy clay
Loamy clay
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
8 Umbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
The water table and soil saturation was not observed within the upper 30" of the soil profile. No
indicators of hydric soils were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 2�2I2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: WI�W�-W�
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, et�.�: Bottomland floodplain Local relief (concave, convex, none): NOne Slope (%): � 1%
Subregion (LRR or MLRA): LRR P �at: 36.127085 Long: -$0.112HO5 Datum: NAD 83
Soil Map Unit Name: Hdtb01'0 IOd111 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetlands WI and WJ are in a floodplain associated with Kerners Mill Creek. WI and WJ are both bounded
by topography to include roads and the creek levee. WI and WJ are separated by a sewer/stormwater
utility easement.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) ✓ Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
✓ Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
��
Surface Water Present? Yes ✓ No Depth (inches): �'2
Water Table Present? Yes ✓ No Depth (inches): $UI'faCe
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
Wetlands WI and WJ are likely inundated throughout much of the dormant season and appears to
receive frequent flooding. Groundwater is present at the surface throughout much of the wetland
and small hummocks/rises are present within the floodplain.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer rubrum 60% Y FAC
z. Liguidambar styraciflua 35% Y FAC
3.
4.
5.
6.
7.
8.
Saalinp/Shrub Stratum (Plot size: 3�� )
� , Acer rubrum
2. Liquidambar styrac�ua
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum
Z. Rubus argutus
3.
4.
5.
7.
8.
9.
10.
11
12
95% = Total Cover
Sampling Point: WI/W�-W�
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 8 (A)
Total Number of Dominant
Species Across All Strata: 9 (B)
Percent of Dominant Species 88.9a�o
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
20% Y FAC FAC species x 3=
10% Y FAC FACU species x 4=
UPL species x 5 =
Column Totals: (A) (B)
30% = Total Cover
25% Y
15% Y
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
FAC Problematic Hydrophytic Vegetation' (Explain)
FACU
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Veaetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
40% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
1. Vitis rotundifolia 15% Y FAC hei ht.
2.Smilaz rotundifolia 5% Y FAC
3.Lonicera japonica 5% Y FAC
4.
5.
6.
25% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
The wetland data point is within a bottomland floodplain forest.
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-3" 10YR 3/5 100%
3-12" 10YR 5/2 70% 7.5YR 4/5 30% C M
12-24" 7.5YR 5/2 90% 7.5YR 5/6 90% C M
24-30" 7.5YR 5/2 100%
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surtace (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Sampling Point: WI�W�'W�
Texture Remarks
Sandy loam
Sandy clay loam
Clay
Sand
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
8 Umbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
The soil profile was saturated throughout. The wetlands are within a floodplain and soils are
indicative of frequent saturation/inundation with alluvial deposition. Below 24" the soil profile
becomes sandy and could not be removed.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 2�2I2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: WL/WM/WN-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.): HIIISIOp2 Local relief (concave, convex, none): NOne Slope (%): 6-1�%
Subregion (LRR or MLRA): LRR P �at: 36.133626 Long: -$0.115312 �atum: NAD 83
Soil Map Unit Name: GUIII2CI Ia11CI NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes No ✓
Yes No ✓
Yes No ✓
Is the Sampled Area /
within a Wetland? Yes No �
WL/WM/WN-UP is N 20' north of and 5' higher in elevation than the wetland data point on the
adjacent hillslope.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reouired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 24�� �
Saturation Present? Yes � No n Depth (inches): >24�� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Liriodendron tulipifera 40% Y FACU
z. Fagus grandifolia 20% Y FACU
g. Acer rubrum 10% Y FAC
4, Oxydendrum arboreum 10% Y UPL
5.
6.
7.
8.
40% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Carya Qlabra 15% Y
2. Acer rubrum 5% Y
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. None
2.
3.
4.
5.
7.
8.
9.
10.
11
12
Sampling Point: W�/WM/WN-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 4 (A)
Total Number of Dominant
Species Across All Strata:
Percent of Dominant Species
That Are OBL, FACW, or FAC:
8 �B�
50% (,4/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FACU FAC species 30% x 3= 90%
FAC FACU species 75% x 4= 300
UPL species 10% x 5= 5�
Column Totals: 115 (A) 440 (B)
Prevalence Index = B/A = 3.83
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
2 - Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
ZD% = Total Cover -
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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
= Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
1.Smilax rotundifolia 10% Y FAC hei ht.
2.Toxicodendron radicans 5% Y FAC
3.
4.
5.
6.
15% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Dense canopy cover with a sparse understory.
Hydrophytic �
Vegetation
Present? Yes No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WL/WM/WN-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 (moistl % Tvpe' Loc2 Texture Remarks
0-5" 10YR 3/2 100% Loam
5-10" 10YR 4/2 100% Loam
10-24" 10YR 7/2 100% Sand
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
Below 24", the soil was too sandy for auger removal/analysis. No water table or soil saturation was
observed within 24".
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 2�2I2O16
ApplicanUOwner: NCDOT State: NC Sampling Point:WL/WM/WN-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Hillside seep Local relief (concave, convex, none): COnCdVe Slope (%): � 1%
Subregion (LRR or MLRA): LRR P �at: 36.133565 �ong: -80.115305 Datum: NAD 83
Soil Map Unit Name: GUIII2CI Ia11CI NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetlands WL, WM, and WN are seep wetlands in small topographic features that are adjacent to
and drain to stream SS. The wetlands are narrow and likely saturate year round by groundwater.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) ✓ Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
✓ Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
✓ Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
��
Surface Water Present? Yes ✓ No Depth (inches): �'2
Water Table Present? Yes ✓ No Depth (inches): $UI'faCe
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No signs of flooding or hydrologic input from stream SS. It appears that the seeps are
predominantly maintained by groundwater seeping from adjacent hillsides. The water table and soil
saturation were both observed at the surface.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. None
2.
3.
4.
5.
6.
7.
8.
= Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, LiQustrum sinense 5% Y FACU
2. Ilex opaca 5% Y FACU
3. Acer rubrum 5% Y FAC
4, Carpinus caroliniana 5% Y FAC
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. None
2.
3.
4.
5.
7.
8.
9.
10.
11
12
Sampling Point: W�/WM/WN-WET
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 4 (A)
Total Number of Dominant
Species Across All Strata: 6 (B)
Percent of Dominant Species 66.7%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
ZD% = Total Cover -
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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
= Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
1.Smilax rotundifolia 5% Y FAC hei ht.
2.Toxicodendron radicans 5% Y FAC
3.
4.
5.
6.
5% = Total Cover
Hydrophytic
Vegetation
Present? Yes � No
Remarks: (Include photo numbers here or on a separate sheet.)
The canopy trees are located in upland areas. The sapling/shrubs present are small.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-5" 10YR 4/1 100%
5-10" 10YR 4/1 60% 10YR 6/1 40% D M
10-14" 10YR 6/2 100%
14-24" 10YR 6/1 100%
24-30" 10YR 5/1 100%
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Sampling Point: WL/WM/WN-WET
Texture Remarks
Sandy loam roots present
Sandy loam
Sand
Sandy clay
Sandy clay
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
The water table and saturated soils were observed at the surface.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760
ApplicanUOwner: NCDOT
cityicounty: Kernersville/Forsyth Sampling Date: 2�2I2O16
State: NC Sampling Point: WD-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.): HIIISIOp2 Local relief (concave, convex, none): NOne Slope (%): 3%
Subregion (LRR or MLRA): LRR P �at: 36.128439 Long: -$0.115145 Datum: NAD 83
so�i nnap ur,�t rvame: Fairview fine sandy loam NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes No ✓
Yes No ✓
Is the Sampled Area /
within a Wetland? Yes No �
WO-UP is N25' west of and 1.5' higher in elevation than the wetland data point. The upland data
point was taken toe of a roadside fillslope.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reouired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 26�� �
Saturation Present? Yes � No n Depth (inches): >26�� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer rubrum 20% Y FAC
z. Liriodendron tulipifera 20% Y FACU
3.
4.
5.
6.
7.
8.
40% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Acer rubrum 5% Y FAC
2. Rosa multiflora 5% Y FACU
3. Liquidambar styraciflua 5% Y FAC
4, LiQustrum sinense 5% Y FACU
5. Ilex opaca 5% Y FACU
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Allium canadense
2.
3.
4.
5.
7.
8.
9.
10.
11
12
Sampling Point: WO-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 6 (A)
Total Number of Dominant
Species Across All Strata: 11 �B�
Percent of Dominant Species 54.5%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
25% = Total Cover -
data in Remarks or on a separate sheet)
5% Y FACU _ 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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
= Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Toxicodendron radicans 5% Y FAC hei ht.
2.Lonicera iaponica 5% Y FAC
3.Smilax rotundifolia 5% Y FAC
4.
5.
6.
15% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-2" 10YR 3/3 100%
2-10" 7.5YR 4/6 100%
10-18" 7.5YR 5/6 100%
18-24" 7.5YR 4/6 100%
24-26" 10YR 4/4 100%
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Sampling Point: W�-UP
Texture Remarks
Loam
Sandy loam
Loam
Sandy loam
Sandy clay loam
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
No hydric soil indicators were observed at the upland data point.
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 2�2I2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: W�-W�
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Floodplain Local relief (concave, convex, none): COnCdVe Slope (%): 1-2%
Subregion (LRR or MLRA): LRR P �at: 36.126585 �ong: -80.113299 Datum: NAD 83
so�i nnap ur,�t rvame: Fairview fine sandy loam NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetland WO is a floodplain wetland adjacent to perennial stream SS. WO is mostly within a
maintained power-line utility easement.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) ✓ Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
✓ Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
��
Surface Water Present? Yes ✓ No Depth (inches): 1
Water Table Present? Yes ✓ No Depth (inches): $UI'faCe
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
The water table and soil saturation was observed at the surface within depressional pockets in the
wetland. Surface water to a depth of N1" was also observed in the depressions. Hydrology appears
to be from a combination of groundwater and flooding from stream SS.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer rubrum 20% Y FAC
2.
3.
4.
5.
6.
7.
8.
2�% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, LiQustrum sinense 5% Y FACU
2. Liquidambar styrac�ua 5% Y FAC
3. Rosa multiflora 5% Y FACU
4.
5.
6.
7.
8.
9.
10.
15% = Total Cover
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum 30% Y FAC
Z. Rubus argutus 25% Y FACU
3, Juncus effusus 10% N FACW
4.
5.
7.
8.
9.
10.
11
12
Sampling Point: W�-W�
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 4 (A)
Total Number of Dominant
Species Across All Strata: � (B)
Percent of Dominant Species 57.1%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
_ 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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
65% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Lonicera_japonica 35% Y FAC hei ht.
2.
3.
4.
5.
6.
35% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Sampling Point: WO-W�
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 (moistl % Tvpe' Loc2 Texture Remarks
0-6" 10YR 4/1 85% 7.5YR 4/6 15% C PL Loam
6-14" 7.5YR 5/6 100% Sandy loam
14-24" 10YR 5/8 80% 10YR 6/3 20% D M Sandy loam
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
Much of the wetland is within a power-line utility easement.
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 2�2I2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: WP'UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Bottomland Local relief (concave, convex, none): COnCdVe Slope (%): 1-2%
Subregion (LRR or MLRA): LRR P �at: 36.126546 �ong: -80.113370 Datum: NAD 83
Soil Map Unit Name: Hdtb01'0 IOd111 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present? Yes ✓ No
✓ Is the Sampled Area /
Hydric Soil Present? Yes No within a Wetland? Yes No �
Wetland Hydrology Present? Yes No ✓
Remarks:
WP-UP is N20' west of and 1' higher in elevation than the wetland data point.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 3��� �
Saturation Present? Yes � No n Depth (inches): >30�� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No indicators of wetland hydrology were observed at the upland data point. While WP-UP is located
within a floodplain, Kerners Mill Creek as been historically incised and artificial levees were created
west of Hopkins Road that prevent frequent flooding in much of the floodplain.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Platanus occidentalis 40% Y FACW
z. Acer rubrum 30% Y FAC
g. Prunus serotina 25% Y FACU
4.
5.
6.
7.
8.
95% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, LiQustrum sinense 15% Y FACU
2. Rosa multiflora 10% Y FACU
3. Liquidambar styraciflua 5% N FAC
4, Acer rubrum 5% N FAC
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. None
2.
3.
4.
5.
7.
8.
9.
10.
11
12
Sampling Point: WP-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 4 (A)
Total Number of Dominant
Species Across All Strata: � (B)
Percent of Dominant Species 57.1%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
35% = Total Cover -
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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
= Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Lonicera_japonica 10% Y FAC hei ht.
2. Vitis rotundifolia 1°/ Y FAC
3.
4.
5.
6.
2�% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic
Vegetation
Present? Yes � No
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-12" 10YR 4/4 95% 7.5YR 4/6 5% C M
12-20" 10YR 3/2 95% 7.5YR 4/6 5% C M
20-24" 10YR 4/3 100%
24-30" 2.5Y 6/2 95% 5YR 3/4 5% C M
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Sampling Point: WP'UP
Texture Remarks
Sandy clay loam Faint concentrations
Sandy clay loam
Sand
Sandy loam
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
No indicators of hydric soil were observed at the upland data point.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760 cityicounty: Kernersville/Forsyth Sampling Date: 2�2I2O16
ApplicanUOwner: NCDOT State: NC Sampling Point: WP'WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Floodplain pool Local relief (concave, convex, none): COnCdVe Slope (%): �1%
Subregion (LRR or MLRA): LRR P �at: 36.126585 �ong: -80.113299 Datum: NAD 83
Soil Map Unit Name: Hdtb01'0 IOd111 NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetland WP is a flooplain depressional feature located between stream SV, Kerners Mill Creek, and
Hopkins Road. Approximately half of WP is within an overhead power-line utility easement. WP may be
isolated except during flooding events from Kerners Mill Creek.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
✓ Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (B2) Recent Iron Reduction in Tilled Soils (C6) Crayfish Burrows (C8)
✓ Drift Deposits (B3) Thin Muck Surtace (C7) Saturation Visible on Aerial Imagery (C9)
Algal Mat or Crust (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
✓ Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surtace Water Present? Yes ✓ No Depth (inches): 1'2
��
Water Table Present? Yes ✓ No Depth (inches): $UI'faCe
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
Wetland WP is within a floodplain of Kerners Mill Creek. Both Kerners Mill Creek and stream SV are
deeply incised on the west side of Hopkins Road. WP likely receives hydrology from infrequent
flooding of nearby streams and from stormwater from upslope neighborhoods and Hopkins Road.
Water is also perched at WP due to a restrictive clay layer at N8" deep.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Platanus occidentalis 40% Y FACW
z. Acer rubrum 10% N FAC
g. Fraxinus pennsylvanica 10% N FACW
4.
5.
6.
7.
8.
Saalinp/Shrub Stratum (Plot size: 3�� )
� , Acer rubrum
2.
4.
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Rubus argutus
2.
3.
4.
5.
7.
8.
9.
10.
11
12
60% = Total Cover
Sampling Point: WP-WET
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 5 (A)
Total Number of Dominant
Species Across All Strata: 6 (B)
Percent of Dominant Species 83.3%
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
30% Y FAC FAC species x 3=
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
30% = Total Cover -
data in Remarks or on a separate sheet)
9�% Y FACU _ 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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
90% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
1. Vitis rotundifolia 5% Y FAC hei ht.
2.Toxicodendron radicans 5% Y FAC
3.Lonicera japonica 5% Y FAC
4.
5.
6.
15% = Total Cover
Hydrophytic
Vegetation
Present? Yes � No
Remarks: (Include photo numbers here or on a separate sheet.)
The sapling shrub layers are present within the easement and are dominated by blackberry.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-8" 10YR 4/1 70% 7.5YR 4/6 30% C M
8-24" 10YR 3/1 90% 7.5YR 4/3 10% C M
24-30" 7.5YR 5/1 100%
30-36" 7.5YR 5/1 75% 7.5YR 4/4 25% C M
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surtace (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Textu re
Clay loam
Clay
Sandy clay
Cla�
Sampling Point: WP'WET
Remarks
OM throughout
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
8 Umbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
The water table and soil saturation were observed a the surface. A hard restrictive clay layer is
perching the water. 1-2" of standing water was observed within the wetland.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760
ApplicanUOwner: NCDOT
cityicounty: Kernersville/Forsyth Sampling Date: 2�$I2O16
State: NC Sampling Point: WQIWWWS-UP
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.): SliCjht hIIISlOp2 Local relief (concave, convex, none): COnCdVe Slope (%):
Subregion (LRR or MLRA): LRR P �at: 36.126845 �ong: -80.115648 Datum: NAD 83
so�i nnap ur,�t rvame: Water (No longer accurate as pond is drained) NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes No ✓
Yes No ✓
Is the Sampled Area /
within a Wetland? Yes No �
WQJWR/WS-UP is on the upland edge of the former pond bed associated with a series of
connected, constructed fish hatchery ponds.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
Saturation (A3) Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (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 (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surface Water Prese?t? Yes � No I v I Depth (inches): >
Water Table Present. Yes No II Depth (inches): 3��� �
Saturation Present? Yes � No n Depth (inches): >30�� Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
No wetland hydrology indicators were observed at the upland data point. Pond at WS was drained
N5-6 years ago, whereas the ponds associated with WQ/WR were drained N20 years ago.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Acer rubrum 40% Y FAC
z. Liquidambar styraciflua 40% Y FAC
g. Liriodendron tulipifera 10% N FACU
4.
5.
6.
7.
8.
90% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Acer rubrum 20% Y FAC
2. Liquidambar styrac�ua 20% Y FAC
3. Ligustrum sinense 15% Y FACU
4, Rosa multiflora 5% N FACU
5.
6.
7.
8.
9.
10.
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum
Z. Rubus argutus
3.
4.
5.
7.
8.
9.
10.
11
12
60% = Total Cover
50% Y
10% N
Sampling Point: WQ/WWWS-UP
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 8 (A)
Total Number of Dominant
Species Across All Strata: 9 (B)
Percent of Dominant Species 88.9a�o
That Are OBL, FACW, or FAC: (A/B)
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
FAC species x 3 =
FACU species x 4 =
UPL species x 5 =
Column Totals: (A) (B)
Prevalence Index = B/A =
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
4 - Morphological Adaptations' (Provide supporting
data in Remarks or on a separate sheet)
FAC Problematic Hydrophytic Vegetation' (Explain)
FACU
'Indicators of hydric soil and wetland hydrology must
be present, unless disturbed or problematic.
Definitions of Four Veaetation Strata:
Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or
more in diameter at breast height (DBH), regardless of
height.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
60% = Total Cover
Woodv Vine Stratum (Plot size: 3�� ) Woody vine - All woody vines greater than 3.28 ft in
�.Lonicera_japonica 5% Y FAC hei ht.
2.Toxicodendron radicans 5% Y FAC
3.Smilax rotundifolia 5% Y FAC
4.
5.
6.
15% = Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
Hydrophytic
Vegetation
Present? Yes � No
Herbaceous vegetation and sparse sapling/shrub cover present in the relict pond bed, while the canopy trees and vines
are present on the berm.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-3" 10YR 3/3 100%
3-10" 10YR 4/4 100%
10-15" 2.5Y 5/4 85% 7.5YR 5/6 15% C M
15-30" 10YR 4/1 80% 10YR 5/6 20% C M
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surface (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Sampling Point: WQ�W�WS-UP
Texture Remarks
Sand
Sand
Clay
Sandy clay
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surface (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
BUmbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
No hydric soil indicators were observed at the upland data point.
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No �
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region
Project/Site: TIP U-5760
ApplicanUOwner: NCDOT
cityicounty: Kernersville/Forsyth Sampling Date: 2�$I2O16
State: NC Sampling PointWQIWWWS-WET
Investigator(s): R. Sullivan/J. Hartshorn (Kimley-Horn) section, Township, Range: K2CI12CSVIII2
Landform (hillslope, terrace, etc.�: Relict pond Local relief (concave, convex, none): COnCdVe Slope (%): � 1%
Subregion (LRR or MLRA): LRR P �at: 36.126916 �ong: -80.115673 �atum: NAD 83
so�i nnap ur,�t rvame: Water (No longer accurate as pond is drained) NWI classification: N/A
Are climatic / hydrologic conditions on the site typical for this time of year? Yes � No� (If no, explain in Remarks.)
Are Vegetation Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes � No �
Are Vegetation Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc.
Hydrophytic Vegetation Present?
Hydric Soil Present?
Wetland Hydrology Present?
Remarks:
Yes ✓ No
Yes ✓ No
Yes ✓ No
Is the Sampled Area _/
within a Wetland? Yes ♦ No
Wetlands WQ, WR, and WS are all concave depressional wetlands within a series of relict pond
beds that were drained 5-20 years ago. The wetlands are bounded by topography on all sides.
HYDROLOGY
Wetland Hydrology Indicators: Secondar Indicators minimum of two re uired
Primarv Indicators (minimum of one is reauired: check all that applv) Surface Soil Cracks (B6)
✓ Surface Water (A1) True Aquatic Plants (B14) Sparsely Vegetated Concave Surtace (68)
✓ High WaterTable (A2) Hydrogen Sulfide Odor (C1) Drainage Patterns (B10)
✓ Saturation (A3) �/ Oxidized Rhizospheres on Living Roots (C3) Moss Trim Lines (616)
Water Marks (B1) Presence of Reduced Iron (C4) Dry-Season Water Table (C2)
Sediment Deposits (B2) Recent Iron Reduction in Tilled Soils (C6) Crayfish Burrows (C8)
Drift Deposits (B3) Thin Muck Surtace (C7) Saturation Visible on Aerial Imagery (C9)
Algal Mat or Crust (B4) Other (Explain in Remarks) Stunted or Stressed Plants (D1)
Iron Deposits (B5) ✓ Geomorphic Position (D2)
Inundation Visible on Aerial Imagery (B7) Shallow Aquitard (D3)
Water-Stained Leaves (B9) Microtopographic Relief (D4)
Aquatic Fauna (B13) FAC-Neutral Test (D5)
Field Observations:
Surtace Water Present? Yes � No I v I Depth (inches):
Water Table Present? Yes ✓ No II Depth (inches): $UI'faCe
Saturation Present? Yes � No n Depth (inches): $UI'fdCe Wetland Hydrology Present? Yes n No �
includes ca illa frin e
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:
Wetlands WQ, WR, and WS are sustained by groundwater and precipitation. WQ has standing water
throughout, while WR and WS have pockets of surface water. There are numerous artificially placed
boulders and large rocks in and around WQ.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

VEGETATION (Four Strata) - Use scientific names of plants.
Absolute Dominant Indicator
Tree Stratum (Plot size: 3�� ) % Cover Saecies? Status
�. Salix nigra 10% Y OBL
2.
3.
4.
5.
6.
7.
8.
1�% = Total Cover
Saalinp/Shrub Stratum (Plot size: 3�� )
�, Salix niQra 5% Y
2. Platanus occidentails 5% Y
4.
5.
6.
7.
8.
9.
10.
Sampling Point: WQ/WWWS-WET
Dominance Test worksheet:
Number of Dominant Species
That Are OBL, FACW, or FAC: 5 (A)
Total Number of Dominant
Species Across All Strata:
Percent of Dominant Species
That Are OBL, FACW, or FAC:
5 �B�
100% ��8�
rrevaience inaex worKsneet:
Total % Cover of: Multiplv bv:
OBL species x 1 =
FACW species x 2 =
OBL FAC species x 3=
FACW FACU species x 4=
UPL species x 5 =
Column Totals: (A)
Prevalence Index = B/A =
10% = Total Cover
Herb Stratum (Plot size: 15� )
�. Microstegium vimineum 40% Y FAC
Z, Juncus effusus 40% Y FACW
3. Scirpus cyperinus 15% N FACW
4.
5.
7.
8.
9.
10.
11.
12.
95% = Total Cover
Woodv Vine Stratum (Plot size: 3�� )
� .None
2.
3.
4.
5.
6.
= Total Cover
Remarks: (Include photo numbers here or on a separate sheet.)
�B)
Hydrophytic Vegetation Indicators:
_ 1- Rapid Test for Hydrophytic Vegetation
X 2- Dominance Test is >50%
3 - Prevalence Index is <-3.0'
_ 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.
Sapiing/Shrub - Woody plants, excluding vines, less
than 3 in. DBH and greater than or equal to 3.28 ft(1
m) tall.
Herb - All herbaceous (non-woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody vine - All woody vines greater than 3.28 ft in
Hydrophytic
Vegetation
Present? Yes � No
The eastern relict ponds were drained over 20 years ago, whereas the western pond was drained N5-6 years ago due
to a breech in the pond berm.
US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0

SOIL
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of ind
Depth Matrix Redox Features
�inchesl Color (moistl % Color (moistl % Tvpe' Loc2
0-5" 10YR 5/2 90% 7.5YR 4/6 10% C PL
5-9" 7.5YR 5/3 100%
9-15" 10YR 5/2 85% 10YR 5/6 15% C M
15-20" 10YR 5/1 90% 10YR 6/6 10% C M
20-25" 10YR 6/1 95% 10YR 5/6 5% C M
'Type: C=Concentration, D=Depletion,
Hydric Soil Indicators:
Histosol (A1)
Histic Epipedon (A2)
Black Histic (A3)
Hydrogen Sulfide (A4)
Stratified Layers (A5)
2 cm Muck (A10) (LRR N)
Depleted Below Dark Surface (A11)
Thick Dark Surtace (Al2)
Sandy Mucky Mineral (S1) (LRR N,
MLRA 147, 148)
❑ Sandy Gleyed Matrix (S4)
BSandy Redox (S5)
Stripped Matrix (S6)
Type:
Depth (inches):
Remarks:
Sampling Point: WQ�W�WS-WET
Texture Remarks
Clay
Sand
Sandy clay
Sandy clay loam
Sandy clay
RM=Reduced Matrix, MS=Masked Sand Grains. ZLocation: PL=Pore Lining, M=Matrix.
Indicators for Problematic Hydric Soi
❑ Dark Surtace (S7) 2 cm Muck (A10) (MLRA 147)
8 Polyvalue Below Surface (S8) (MLRA 147, 148) � Coast Prairie Redox (A16)
Thin Dark Surtace (S9) (MLRA 147, 148)
Loamy Gleyed Matrix (F2)
✓ Depleted Matrix (F3)
Redox Dark Surface (F6)
Depleted Dark Surface (F7)
Redox Depressions (F8)
Iron-Manganese Masses (F12) (LRR N,
MLRA 136)
8 Umbric Surface (F13) (MLRA 136, 122)
Piedmont Floodplain Soils (F19) (MLRA 148)
❑ Red Parent Material (F21) (MLRA 127, 147)
(MLRA 147, 148)
� Piedmont Floodplain Soils (F19)
(MLRA 136, 147)
❑ Very Shallow Dark Surface (TF12)
� Other (Explain in Remarks)
3lndicators of hydrophytic vegetation and
wetland hydrology must be present,
unless disturbed or problematic.
Hydric Soil Present? Yes n No ❑
The water table and saturated soils were observed at the surface. The soils were to saturated and
sandy for removal/analysis.
US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0

�_ _
I usa.�� ,��n�_
��- -.. _ ___ —.,� -.�._—._._�_
� ���—� ��
Cl WQ # 5ite # �ondicate on atta�hed map)
� S��R�AM Q�AI..I3"Y" ASSE��ME�'wiT WC}�tKS�E�T � _,
� ,,� ; � . � ",;�1
,.��— , '.,� r,-�:
P"ruvidc t�e fo�lawing infarma#ion f+or the stream reach under assessr�ent: �
1. Applicant's name , ' - 2. Evalu�tor's narrte; �:.T'_ ���,�� ;� r' �. `� .
� d I ' " _..��
3. Date ofevalu�tic�n: �" � �-^ � �''' � �- 4. �'irne o�`eval�aatior�. r; , � ,J
� i
,�i. Narr�e o� strearn: ` -.",. '�� f» F�iver bas�n. _ :: 'i� ` � y`,"
s
7. Appresxima�e drairaa�e area: �� .''- 8. Stream order: �
9. Len�th af reach evalua.ted: � 14. Caunry;
l l. �ite ct�ardinates (if knc��+a�)„ prefer is� decima➢ degrees. 1�. Subdiv�sian name (if any}:
;� ,u'' �r �' �- �'
L�til��ie (ek�. 3�.s7��12�: � � � �� ` L�ra�,�itude (�x. —77.5�E61 1): �' ��1� - _;'�
Metltaci 1+�cation c�eterrnia3ed (�ircie}; Cif'9 7'��t� Shc�;t t)riha {�ic�ial) T'i�otol('�i5 �ther �IS C?ihcr
�3. L�eativn of'r��c;li uwider ew��Iuatoc�r� {nate rzearby ro�ds �nd �and�narks ancf'attach map ide�tifying stream{&} 6ocation):
14. Prapased chann�l �,varic (ifany
,- -- -
15. �ec�nt �ea�her canditions. F - - �' ` -
1 fi. Site canditio�s �t tirrre vf visi�: '�
i7, Identify any special waterway ciassificat�orss known. _Sectio�i 10 Tidal Wacers �Essential FisFaeries Habitat
�Traut �+`�ters iC3utstanclin� Res4urce W�t�rs � Nutrier�t Sensit`�+e Waters '.�;!�Water Supply Watershed �� (I-["Vj
1$, 1s ther� a pand ar la�e lacated upstream af the evaluation �int'� Y�'� t�f3 lfyes, estimate the water surface area: `' "'
i'9. C��es cha�jn�� �pp�ar an [J�GS t�uad map? YE�S 1�JC) �4. Docs channel ap,�ear on iJSDA Soil 5�rvey? 'Y� NQ
21. �stimated water�hed iand use; °/� f�esici�ntial % Cc�mmercial %� �rr�ustrial
_%a Forested _°fo Cleared / I,ag�ed _°10 dthee (�
2�. Ba�l�full
23. Sarak hei�'�t Qfram bed to top mf ban
�%a Agr�c�ltural
24, Channel sic,pe down center afstream: eFlat (4 ta �°toj ,�Gentie (2 to 4%�� �Mvderate (4 to 1U%) _Steep (�10%)
2S, �hannel sinur�sity: , Stra{ght �ccas'snnai bends F're�uent rr�eaarder _�'�ry sinuous Bs�a7�3�d channe�
Instr�rction� for cur�pletaon a'� warksheet (Nocated on pa�e �): I�egin tay d�termiming &he lnvst appropraat� e�c�regicsn based r�n
lo�ation, terrain. v��ctati�n, stre�n� classifieatibn, etc. �very e�ar�cieristic maast �e scored usin� t�e same ecoregi�n, Assi�n p4inas
tc� each character�stic w�ithin tihe ra��e s3�mwn far the �c�re�ion. P�ge 3 provides a br�ef descriptivn vf ho�v to reView the
char�eterisfi�s identifiec9 ir� the w�orkshee�. Scores should reflect an avera�l assessr�ent of the str�asa� reach und�r ev�.Yaxatiara. If a
ch�racteristic cannat be evaluated due ta site or weather c�rrnditions, er�ter 0 ir� the sce�ra�g bc�x a�d �r�vide an explana�ion 'rr� ihe
comtt��nt section. Where there are obvious changes in the �haracter of a stre�rr� �n�1er review (e.g., the strearn f�ativ� from a pasture
into � forest), the st�e�n� may he di�ided inta smal�er reacFies that display rnore cantinuit�r, and a separaYe form used �a evalvate each
reacl�. The tatai score assi�ned to a stream reac� must r�r��e betw�en 0 and 1�0, with a scare vf i�?0 representin� a strcam nf ��e
hi�i�est quality..
�}, .�
"C'v�al Se�rre {frvm r�verse), � ' �-� C�m�ne�ts: - ��" �e�"� � - V' � - '' �" �� -`�'
G�X= `._ , ,
�
„ �
�ualuator's Signature - 1�ate '
This c�+arar�el ev�l��Nian f��m �s i�tentied to be use�i na�ly as a gaicie tr� assist l���a�wners a�d environrnental pra�fessianals in
g�thcri�n� tl�e data required by the LDnite�i States �rmy Ccrr�s of En�inecrs tQ �a�ce a prelimir�ary assessr�e�k of s�r+ea�
qual�ty, Th� tot�� score resulting frvm �he eompletion of this f�rm is sul�ject to CJS�►C� approval and �r�es nat imply a
�articular mitigatiun r�t�a or rec�xrir�trnerwfi. �rerna su�rject tc� change - r+ersic�n (1�i,�0`�. '1"�r �Cott3t�teni,, p4ease call 919-$76-84'4d x 26.

ST�EA� QIJALITrY ASS�S�1V���VT WD�KSHE�T
' #€ C'H,�►R�C"T'ER[ST6C;� �CC)IZrG�O� 1'C1�7�1T ItANf:��;
� C'e��stal f'iedinont '�ic�untain
� i'� r.5cnee nf fl�asa '��� rs"ssten# (�oc�ts ira �treain �-- 5 Q_�} �-�
r�� tZ�»r �+€• ��€tiir�ttic�i� f1: 5trc�i��� �lo�v -� €n�3x p�anf.�}
_�_ . _.__
� F;vi�ei�ce of past hiirnan altei atinrn Q� �-� �- 5
(exTe.nssvc alle�';t4iurt f); �n altet�al3casa t�la� �c�i�it5j
� Eti�bari:�� ra�ne 0- 6 0-� 4�- 5
�no {��ffer = �; c�nti�u�a�tas� �vide buffen� _ ���x �irats}
E�wi€�ence o6 Etuti•icrat: or ct�ett�ieal �lisc���rges
q (} - 5 �J _.. ,� �l -- �
('�:�t�nsi��e tlis:lzar:,=es f); no dischar�'�s = man �,�rint5)
. _ _. _
� � {,�-<���nclrv�tec ciischarae � - 3 � - 4 (} - 4
d" n€� disc�i�rne (7 s ritZt�s se��4 ���tlan�� etc =�nax .ointsf - --
� � P►�e�ence flt ad�aceni f�c�ocipla�n � - 4 � - � � - �
� r�� t`9�c�d ]aui - G�; extcnsive f�c���ci la�n - 37�nr c�ints
7 E��tre�chment 1 flntBa��>l.�`sn �c�ess �__ 5 p_ 4 �-�
�'+ ���e�pl ' entrenci7ec➢ �- t�: �rec�isenl il�����l�r� Qnax noi��ts3
$ Pa-eseR�ce t3f �dNaeent wetiancis � � 0 - � -� _ �
(na v�-etl��i�cis -�: l�r�e adj�c�ret 4vetlands � tt�ax pc�ints)
� � f�'h��nnel sinur;rsity � _ � i� - =} D - 3
f extens'r�•e ehann�iic�tic�r� �t; ila�its��sl me<inc��r = rtaax c��nts�
SetJd�net}t i��p��t
[d� Q-5 t'� -4 0-�
��?�ten5ive �ic��t�,i�ia3n-� 4, li�t1� �E� ��o secii�rnu€ig- ��ta.� pain�s)
�_...� -
1� Size �i �itversitv t��' c-Fa�n�re1 b+e�l su�sirate ?\!:,� M () ... ,� 0-�
(fine, i7oi�ic�zenc�us -�} i ar�c. dn�erse s�ees == i7aax p�.7icroYs}
�.virlef�ce af chano�! ii�ci�ian or widenan� {
1� 0-_. 0-4 0-�
7„ (cice�l� �raciscd� = U; st�.hl� b�d c�_ ���i�;s �- �n�� _oi��t�sb _
'�,,,�'' j� I'�•ese;►re of majc�r E}.�nk fai{ures i) - S q- 5 U. 5
� (sever� �rc�sion 0; nc� er�si��it, stable h�inks = tn�x nints}
� f 4 {»o ��w�i�lc rk�€�ot c�e}�th aE1t1 �let�sif�� ��t b�nl�s �- 3 0- 4 �? - 5
� .` y ac5ty �1: d�P�tie ra�t� tha��ou<�,��oiat = d�tax �oa��ts)
�.__ _. .
r/� !t�'��act by a�riculture, 9ivcst�ek, n►• tiirtf�er r�rr�dluc4ic�n
15 . . � -� (}--4 �-�
l'�ta[�;tat�tial i���4sact ={}; t�[� evidt.i�cc = n�a� �c�i�7Esf_ ._
i� Preser�:cc c�i rif'��a��oat/r�p�rlc-��a�c�i cvrn�rlcxes �- 3 {} - 5 �} - 6
�no riffl�s'rip�ics or p���1s�1�; - CT; �n�1V-�lev�in � ed = r�7ax �ac�ints) �
� 3 ��i1�76�.it fUl'il}34Ctit�i' � — i�. � — �r � — �
F �� ( liit4e crr nn h<if�itat -- �l; f��;quei�t, varie�l hal7itats n�ax airits)
p� 1$ C:an�p�s� cati°era�,� 4�ti•e�' str+�slrnE��c� �_� ,� -� �� r
(r�� Sk+arlisi� �•e�;etaTipr� _ (i; c:c�iat�r�ura�s_� ���k'_=_n�ax ou7ts}
x 1 � ' . Suh�traf� et��bet1[3etin�5s N ,�� � .- � p - �
{¢�ee�lv �:Ittbec�dct� fJ: 1uc�se �triii;iaire - ina�,) -
j ,��) Preserzce of strearn in�,�exYebr:�Yes (se� �a�;e 4) �) - -� 0 - � �y - �
� �racr er itiunec -(�; e�ntna�,n. �iun7c:rt���s tv es - cnax . c�istis)
' � ' ,� V Pre�ence of .�n��r��ibi �ns � - ,� 4 - 4 Q -- �4
Q `" {no �v�dence `[7; cc�i�inu�rr_ t�ikn-�c.�•c»s t�es = tnax pt�in�s} '
1'rearnc.e �f ��}i
. �7 L1--4 4-� (}�4
�
'�; � no evi�ier�ce (�; ��arinic,ii. Qii�r7aeruazs t.�,�es - i��ax t�ints)
..�, _._ _ -
"" �� [.��i€�enee c�9' e+ifciqif'e use � �- 6 p._. S (3 - 3
_' (ztca evicfien4� ,r): t�bt�ncliirit evidence - 3n�x t�inty) _,_ _
Tt�taE P�in�s F'us:.it�le f li)� 1U�7 1�f�
° �_
_... �_- TOTAL SCC)RE �als� e�ter on first pa�e)
'' `1'�ic5e cliar'xcl�:risiics are n�t asses�e�i isi cQasta9 strearns,
SCf)H� F

NC D'kL� Stream I�ientificatia�n Forxn Versir�n 4.l 1 ��
F��te: Proj�ctJSite: -- Latitude: :;; 1'�'.�'•� .�' 1'
Evalua#or; Cvunty: .:� Longitude. - ��. � ',�,':, "-�
T[�tal P[rints: Strearn Deierrrrinatio�-(circle one� Cither
S#rearr� rs aP least rnterma'�tenf Ephemea`af 6nterm�ttent Perenrtial e.g. Quad Name:
il � 19 or nerennial rf - 3(}`
A. Gec�mor haic� (Subtotal = } Abs�nt Weak Moderate Stre�ng
1� Continuity of channsl bed �nd #aank 0 1 2 3
2. SirauosEty of ch�nnep along fha'Iweg 4 1 2, 3
3, 1n-channel stru�ture: ex. riifle-po41, ste�_pool, p �' 2 3
ri le- ool se �aence
4, i'article siz� c�f s#ream substrate Q 1 2 3
a. Activ�lrelict fl�c�d��aln {1 1 2� 3
6. Deposdtloraaf bars c�r benches � � � 3,
7. Recent akluviaB de�osits Q '� ` 2 3
8. 6�'eadc�ts {� fi" 2 3 ,
9. �G�ad�; corrtro9 0 0,�` 1 1.5
1 U, �at�ral valley Q - - 4..5 �' 'E 'f _5
11. Secrind ar gre�f�r arder channel No = f� ' Yes = 3
_ rx.._...._ .,� _ .- _ _
�. �'i"�C�f0�0�]f {SllbtOt�4 = }
12. presence ofi Basefkow
13. lr�n c�xidizirrog bacteria
14. Lea� litter
16. Sediment on p6ants or debr�s
16. Qrganic debris fines �r �iles
1"i. Soil-based evidence o# high water k�ble'?
No=O
Yes = 3
3
3
b
1.5
1.5

�" . --.-: . � .
�
�[JSACE A,[I1# i7WQ # _ Site # {i�dicate an attached map� ';
___�__... _..�._..�..... .. .. ..__. - ---- —...� _
,�� S'�'REAM QUAL�TY` ASSESSMEI�T VV�RKSHEET
Frovide the follorvin� informaticrn for t�ac st�r�am re�eh under assessment:
r ��
� ��
�•
�
t. AP�1`scant's ��me:_ 2, Evaivator's na�ne. "
3. Ctate of evalua�ion: 4. Time Qf evaluatic�n: _ �
5. t�lame Qf stream: ��� fi. River basir�: �`J' �; ��' �,,
.,
�. ,
9. i.en h af reach eva[uated: ,���°y` � 8. Stream orcler� '
7, Approxi��ate drasnage area �-%' ,
� `° � ' � - X a. Ca�rrsty: �� � � ��
.�
l 1. Site coordinates [if known) preCer in decimal degr��s, 12. Subdivi�ivn narne (df ac�y): —�
� Yr"�r, i ,� "� - +' � a�:
Latiit�tie (ex. 3�.�72312): _ . _ l.c��agitude (ex. –77.:a5fifiE 1): -~ �` � ; .
Methtid location deizrmi�7ed (circle}; , CiF�S' Tagc� Sh�,�e.t (7rt1ic� (fL�rial) Nl�nt�rJGFS ()tV�er GtS i�rhee
_—
13. Lcaeatic�n of reaeh under �valuatia� �nate nearby roads anc� ia��c3�barks and attac� snap `sdentifyin� stream(s) lvcation}:
14. Prnposed c�annel wark �if ariY): '�
15. Recent weatl�er canciitions: - -_
l�. Site canditions at tirrte afvisit: ' _
17. Identiiy any special waterway �lassiFications kitpwn; _Se�tian 1[D iTicial Waters _Essential Fisheri�es Habitat
_Trau� Waters iC7utstanding Resource Waters �1Vutristtt Sensitive 4Vaters lWater Su�s�l�� Waters�ed -�--�- �4-1V�
18. is thece a pond rsr lake lacated upstream ot'tha evaluatic�rr po�nt? I�ES 1V�C) Zf yes, estirnaie the r�+ater se�rface area:
I4. Dves chanrt�i appear dn [JSGS �uad map`? YES N�
21. Estimat�d watershed lan� use: �% f�esidec��ia!
`°lo FCiieste[{
20. Dpaes ct�annel appcar tin �.JSI)A 5ai� Sur^vey? YES NC)
°/a Comrnerciai _°./a Industa�ial �,°la �4gricultura4
_°!n Cleared ! Log�ed �% �Qt��er (-
22, Banicfull e�ridt�; _ 23. Bank heigi�i {from be� t� tap of ban�}:
24. Channel slt�pe dowr� center r�f str��rr�: ,�'Fiat �;0 to 2%� ��+Gentle E2 to �k%) _Maderaie (�1 ta l0%) _Ste�� (>1�°r'o�
25. Channel si�tuos�ty: 5trai�ht `�,�7ccasional bends �Frequent n�eander �Very sinuous Braided channel
�nstrucdiens for c�mpietian +of wor�Cs%eet (loeated on page 2): E3�gi� by d�termin,ing the z�rost approQr�ate ecs�regior� bas�d nn
]acation, terrain, Ve�et�tian, str�ea7n ciassiticatios�, etc. Every Ghara�teristic musfi be scored using the sanle ecrare�ion. Assign poincs
to each characteristic w+�ithir� the ran�e shown fcrr rthe ecare�ion. Pag� 3 pro�icies a bri�f desc���tion of hcativ to rewiew the
char•acteristics identified in the wprksheet. 5cc�res shcauid refleat a� overa4l assessmeni ca� the strearn reach under evaYuatian. If a
ctiaracteristic cannot �e evaluated due to site or �veather c�nditions, ec�ter Q kn the scc�ri�g box and pcovide an �x�lana4ion in che
�qmment section. W ktere ih�re are obvi€rus �han�es in the el�aracRer of � s4ream ur�der review {e„�., the s4ream fl4ws frveal a. pasiure
into a forest), the stream �a�ay be di�wided inta sm111er reaches th�t display m�re cantis�uit5+� and a separate fc�rtt� us�d #o �waluate each
reach. The total s�are assig�e�! tv � strea�n reach rnust r�nge between a anci 1�}i�, with a scor� af L��3 repres�niing a scr�am of the
lii�hest q'ualaty.
"x'vtal5core {from s-everse): +Cora�r�ents�
_ • ,�
�� � � l'„ r �� ' � �
Evalu�ato�'s �ignatwre ' .. -- Uate , .
"�`B�is ehanne! evalaraxion farrm is inten��r� ta b+� usec3 vnlV as a guicle ta assist larndowrrers an�4 environmental prafessionais i�
ga#hering the data �ec�wired I�r• the U�i#ed States Arrrrrr� Ca�-�s of E�;ineQrs to make a pt'e�iminary assessmes�t o�' si��eatai
�uality. The �at�l scare res�l#in� £rmm tite eorr��letion of t�is fvrm is sal�ject to �JSACE app�'o�ra� a:nd does not imply a
ps�rticular r�iYigatian r�ti� or rec�uirement„ Fn�m subject tQ chan�e - vetsi�n Qbl�3. "i"c� Casnrnet�t, �flease call 919-87b-$4-41 x 26.

#
STREAlV� +QUALITY AS�E�SIVIEN'�' �()�t�{SH�E�'I'
C�IA I� A�'.'TF �t�STIGS
Presencc c�f 1���ti4 (�3�r�istrnt Tatate�s izr tiire;t��
{nc� �ca�� c3r ��ituratiun -(J: sfrcai�� i7<r�4 in��x Cyui«ts}
�:�°i�icnce r�ipast l�wrr�ar� att�ration
(extensiv� afteralior7 - t); nc� alteratinr� = na�.� poii�tsl
Rd���rian �t�ne
��� btrtf�r = 6; cE�r�ti�'uatis, 4vitic h�kffez` = n�aa�a��irst�?
���idei�ce of nutrienk s�r ck�cn�ic:ti ciascl�.�r�es
textcnsBve ciisuh �ry�es �7; i�c,7 c{etic;l��r���:� ����sti �c�intsl
-�-�:aucrun��w.ate�tlis�hait'�,e — -
�ic:� ciischar;e -�l y�,ion�,s, sec��s, tx,�tEt�«���. 4Ec. = er+ar pc?it�t�}
Pr�s�nce �nf ac�jec�nt 9�at�aiEal �ira
(t��t� flc�oci��l�an {3;. e�tcr�sir�c tl�����i��[�tirr - n��ax �c�i���ts)—
�:s��renct�rnent 1 fl�aaciplain aecess
(de�;�1y enTc•encli�cl = {) iz�c�ue�rt C�n<>�lfltnE� _- tnax {,aitYts} .._._
�'rese�n��� of a�c�j�ceRat ���el�! zn[��
(nc� �r;ztlands = (}; lar<�e �c{pac�:nt ��.etl;nr���ls - m�r pc�inks)
�;lsarrncl �;inuueiiv
(extertsive cki�9�iaelizati�m 41�; n<tt�iral t�iear�cler = ntax puini�)
Sedimcnc iE��teit
(exie�nsiv� ci�positic�n= (Y; lit�l� rar r�a sec�ai�ent =�3�as poii�ts)
`�ize .� �liversit} oE' cki�nr�� f 1��e4i st�t�sti•�t�
i1�fl9�e�, hc��1c,��nc7�e�s =�� O 1 lr�,e, da��erse seE�s = i�i<�x �t�ints)
E l:rietenre o�`c�ktaunt9 iE�rision �r rvi���ning
{�eep�ly inui4�ci i:i; ,1 iL7fL be� �.�'; �Sanks - nt�� �rc�iritsl
Pr,esenc:E tii ar�ngur 9as�nk 6�ilures
(s���ere crosic�n -{}: �ltti cn��icari_ st�il�le t�t�nks = tt����: p�int�l
�a�ot ele��tli �►r[! der�+�t�� c�n bf�n�s
�nc� ��iso}�ie �'��ni� - f); eilga�e rctic�ts t1�r�ou<�9�c>uI - m�ti �oia�t�l
��p�e1 k�y ��r�cuat��r�, 1��csFoc'@�, ar �firaik��' �renc�uc�toan
{sti�astanti�l ic�l,�act �J; rtca eE=ideticc an��ti ��it��sl
�_ ['rt�er�ce af r��i't�e-po�lPripn{e-pa�c�l rerri�[zLexes
�itc� r��tlesiri��lts or pao9z ={l; we]V-i�cv�,lo�7eci = s��ax ptaintsl
Fia[�itr3# ec3nr{��exity
(little csr ��c� habbtat =()� f'o�c�Llerj�, v�iri�ci h�t�it�ts = m�� pt7ii�ts
F C;ano{ry' c�vcr:i�K tjver s#rcan�kaeci
{�ca shadin� ve�etc�tic?s� - tl: �nnYia�ut>�is c,���c����. = max �x�iitts'
Suhstr;�te etnf�e�isieclr�es�
(r�e���� eml�ecided = ��: aor�s� scr�i�:z�ire - e7��iti
� �'�'e�es�ee a�#'�i:rcar�f �nverfe9arades �se� �a�e =1}
(no �v�derlce - 0; corrti���t�n, n�a�a�ec�.��is t��res - inax [�ints
_ _. -
i'resrriee nf aru��hibians
(nc� �'��idencG = d�; e:�sr��mcrn, ar�snieru��s 1�_{�es = �ttax�oo�ts}
_.. __ _
1're�ence e�d" t7sh
f no �;ve�lenw� 4,): �:c�mn�r�1��, r�uim���roip5 l)�}��:�s =��a.'� p�ii�ts'}
.��:wir�c;Eice �f ►�•ilcllife ase
QnU ee i�]e��cc - i1; ,�N�ii�l�}.�nt evidc:nx.� - ittax �t�i3�f
{ 9)�.i' �OliliS �f�l4ti1�CC
EC"OREUIfJN PU�NT IZANGE
C€���sts�i 1'iec�ma�a! 1l7a�sntain
4�-5 (�- � �1-3
t�-6 {i_.� i} �
t�-b (7. 4 E� . j
f} -� f?-� Q-4
�-3 �l-4 [�-- �
�,-4 c�—� c3- 2
a—s �—a o-2
Q-G �-4 [1-2
{}-5 � -� C�-�
i9-5 i?-4 0-4
NA� t1-4 f1-S
p.�..� 0-�4 �-�
i�— s a—� 0-5
U-s f�-� (?_.5
p __ s Q � 4-5
�J-3 fl-� Q_6
U Cr i�-6 0-6
(?- � i7-5 f)-�
N�1'� fJ - � (3 - 4
O-4 d'l-=5 0_ 5
t7-� 0-�4 a-�
�-� (�-�4 �b.....4
U - � t�-5 (�-5
_.. ---�---� —
�t�E) g 100 liJi)
_ ...--- ...1_ ......__
'T'C?`1`A�., 4t OFi� (aisc� enter c�n first �a��e)
�`T'i�esc characi+:ristics are t�c�t ��sscs��d i�� co<ist:yt� streai��s.
F?
S�QR�
�
-�

WET�AIVD D�iERMINAT`ION �ATA ,�C]�RM — Eastern N'�ountai�ns and Pi�dmt�rat
Pro ec3lSite: � d� V/--` CitylCounty: Sam�aling �ate: ' ' �^�p "�
1 ;� `
ApplicanUQwner: '`� - �� `� � Skate. Sarr�pfing Point �, �"� �
Inrrestigator(s): 8ection, Township, Range:
Lar�dfvrm (hilislope, terracz, etc.): Lac�9 relief (cnncave;''can�ex, none}: Slope (%}:
Subregion {Lf2R ar MLRA) p�� LaL - Low�g: � 'Datum°
Soil Niap UnEt hhame: - N1MI elassificatiors:
Rre climatic! hydrologic eonditions on the sote typical for this time of year? Yes No dif no, expVain in Rerrxrarks;)
Are Vegetation , Soi! , ar Hydralogy significantly disturt�ed? Are "�lorma! Circumsdanees" present? Yes �a
Are VegeEaiion , 5c�if , or Hydrofogy naturally prablem�tic? (Vf needed, expfain a�tiy answers in Remarks.J
SUMMARY flF FtN[?lNGS — Attach site map showing sam�i�n� point'lacatipns, transects, important features, etc.
, ,,
Hydrophytic Vegetatian P�esent? Yes - Na
FVydric Sail Present? Yes � No
WeUand Hydrology Present? Yes �? �la
Remarks:
HYDR(3LOGY
ls the Sar�opled Rrea
within a Ylfetland? Yes `' ` No
W'etland Hydrotogy Indieators: Secont#anr Indicators fminimurn qf twa reauiredl i
Primar�r fndicators iminimE�m of anc� is reauired� chec�s al[ tha4 applyl � Su�f�ce 5oil Cracks {�6j
� S�r6ace Water (A�l} _ True Aquatic Plants ��14y _ 3parsely Vegetated Cancaue Surface a68}
v N[gh Wataf Ta�rle (A2} Hydragen Sulfide Jdor �C'f ) =✓ Drainage Patiems (810}
T, S�t�sration (P,3} a Oxidized Rhi�qspheres on L4ving �toats {C3y � Moss Trim Lines (B1fi}
Water Marks (61 } _ Peesence of 1�educed iron (Cd} _ Dry-Seasa� Waier Tab9e (C2}
! Sediment C}epasifs (�2) _�tecent Iron 1�eduction in 7iCled �trils �Gf} ` Crayfish Burrpws (C8)
p�ift f�eposfts {�3) _ Thin Muck Sur�ace {C7) _ SaturatGon V'ssible on Aerial imagsry {C9)
Algal Mat ar Crust (84} � Other (Exp6ain in Remarks) �, 5tunted or 5tressed Plants (B� }
f Iron Cleppsits {B5) = Georr�orphsc Posiiian {�2)
� lnundation Visible on Aerial Nmagery ['B7) _ 5hallaw AquiRard (d3j
i Water-Stained Leaves {B9} _ Micrmtnpag�aphic Relief {f�4)
� At�uati� Fauna (B13} _ F�IC-6Ve'utf317e�i (D5)
Field C)bservaiions:
Surface 'VVater Present7 Yes No �� C�:pth (inches}:
x
�AVaterTable �resent? Yes �a �- f]�pth (in�hes): �c-�' _
Sat�aration Present7 Yes ' No [?�pth (inches} '�^�� Wetla�d Hydrology Fresa�nt? Yes -•�,' �40
includes ca itlla 4rin e
Describe Recorded Data (stream gaug�, monitoring well, aerial photos, previous inspectio�s}, if auailable:
�:emarks:
l7S Arrrry Cor�s af Engin�ers �asterr� �+'launtains a�d Pied�ront — lnterdrn Versian

VE�ETAiIQN (F�sur Strata} — Use scientifie n�rrees c�f pEants.
������
� .- � ��
S�r�tpGir�g Point; '
- AbsQlwti� �ominant Iradicator potminance Test workshee#:.
7ree Sfiratum {Plpi skze. _ ) °/u Cov�r SQecies� �Stak�rs Nura�ber of pamnnar�t Sp�cies
•' . � , „ ' , /` r �` � •� . _ Tt12t AFe OBL, FACW, ar FAG:
7. ; '_ ' U _�_
, � - ,e , ,��,
z �-, -
�� - ,� . '�ofal Numb�r o6 �Jom�narr[
3.
6� ��" Species Acrass All Strata:
�. _ � �",-1 �d , � ��_,;".� �,�"; �' ' `
P�rceni of Daerninar�t �pecies
g, 1fhaF Are QBt, FACW, gr FAC
6.
7.
8.
� � � = Total Cou�r
SaolirralShrub Straium (Plot sEze } y
,
,- 'V
,� ' - - -
1. �. , � �,, � .
�� A� � �,�f �
'�.. r : � _ i •� '. - ° �J �
."i- � 1'}. �� e: F Y1 �,,, i Y:.'��"' �'i-+`. ��j�f�
4.
5.
6,
7.
8.
9.
� a.
���=� _ �at�i �o��
Herb Stratum {Flot size; � � 1 ' �y ,�. . .
9. t.rv=. ��:� ,, . �s k, , ,�-,-
�
2. � � t� �s -wr t � p � - °
Ia ri ��..d�1[•., b. .�,�..�. _ k t,:f,. _� ���:: iji�-
4.
5,
6.
a.
8.
9.
'V 0.
'11.
12.
� _,r F
Vlfoadv Vine Str� (P6ot si�e: - )
� - . �
- �,
2.
3.
A,
5.
6.
pho#a num�ers h�e� or on a separate
� i�' = TqtaV Cover
} � ;' �_
e�" �w' = Total �over
� .�;��;� ����
Prerraa�nce Ind�xworksheet:
�Gotal °r'a C�over of: Nlultiolv bv:
OBL species x 1 =
FAC'W speaes x Z =
FAC species x 3 =
FACU s�recies X 4 -
UP� 5�2CI@S x � =
Cviumn Tatals: (A) {B)
Prevalence fndex = BiA =
Wydrssphytic Veg�taf'son lndicators;
_ 1- Rapid T�st fnr Fiydraphytic Vege#atiCrn
�: Y� F- Dominanee Test is >5Q°lo
� r
`'3--Rtevalence�nd�xis s3.(k'
' 4 - M�rphalog�eal Ada�tat9oms' (Provide supporling
data on �emarks or ean � separate ���et}
� Pr+ablernatiC Hydro�hytiC 4'egefation' (Explaie�)
'Ind'ur,a�oss oi tsydric soiG and wetland hydrology m�ost
be present. unless disturtred c�r pr�hGernatic.
Refir�it�ans ai �our Vegeiatior� Strata:
Tr�e - Wopdy plamts„ excluding vin�s, 3 in. (7.6 �) or
nnare in diam�ter at breast height (�BH), pegardless af
height.
Sapling�Shr�cb - WoAdyr plands, �xcluding vines, less
ihan 3 in. D�F� and great�� thar� 3.28 ft(1 m} taVl.
�erb - A11 heeba�e6us (noa-wcsadyi P4ants, regardless
of suze, and v�oady p�ants I�ss than 3.�8 4t talf.
�Ioody uin� -- A!I wmody vones greater than 3.28 ft irs
hei��t.
Hydrophytic
1legetativn } "'
Prteser�t? Yes _ �1�
US p,rrray �arp� of Ersgine�rs �astera �+lounfains and Piedmont a 6nter�rn Versian

5C11I
����1l.[J
Sampl�ng Point: '
Profil� ¢3escript�on: (�escribe to the �iepth needed tca document the ind'acator �re con�rm the absence at indocatars.}
p�pt� ��tr�� Redox Features
(inchesD C�kar fmoistl °!o CoVor tmoist} %b TY02 �. T��cture �ernatks
�
; ,_j � 3� , .
. - _ ;
�,�
,
� ;: � ; , - --- -- -- -- - -
Nydric Soi3 Bndicators:
His4osal �A1)
Histic Epipedon (A2y
� Black Histic (A3]
! hlydTtrgen Sulfrd� (A4y
_ Stratafed Layers (A5}
2 cm tvtuck (Ft�'{i} (�Rit N)
� E?epletsd Belt�w �ark Surf�c� (A1�)
Thick [7ark SuEface (A�2)
' Sandy Muaky Mineral (S1J (LRR N,
MLRA 147, �48)
Sandy Gleyed Matrix (S4)
' Sandy Redox (S5)
' Sttippec� TJlat�ox t56)
ftestrictEve Layee (ifi obsenred):
Tiype:
aep4h �incheS}:
�IS Arrny Carps ot'�ngineers
Pndicators 4vr Prc+blematic Hy�lric Soi4s':
17ark Surface (S7} _ 2 cm Nluck {A10) {1NL�FtA 147)
� Pc�9yvalue Belaw Sur��ce (58] (fNLRA 147, 148j � Gaast Prairie Redax (A16)
Thir� [3artic Surface (S9) (MLRA 147, 'i48j (MLEtIa '947, 14$�
� Laarny Gleyed Ntatrix (F2} ^ Piedmont FVoodpla�n So�ls (F19}
i�epl��eti MaYrix �(F-3� (GhA�.RA 936, 147�
�,.r'Redc�x Da�k Sur#ace-#FFs}' � �Zed �arent M�teeial (TF2�
depl�ted �ark �u�iace {F7� �. VerY ShalAow 43ark Surfac� (TF12}
�, Rt;dox C�epressdons (F&} _ C�thee (Explain ir� Remarksy
Iran-Manganese Masses (F12} {LRR N,
� MLRA 136J
Umbric Surtace {Ft3) {lNL.32A 136, 122) 3lndicators oi hydraphyt6c vegetation and
Piedrnant Flaodplain So�Vs (F19) (6UfLRA 148j wetland hydro1ogy �musi be present„
'� unless disturbed or protrle�mafic.
' �,:
liydric Soil Presen't? Yes ' w _�+�
Eas4ers� Arloa�ratains and Piedmc�ni � Intsrim Versior�

,�5�-�,�� � �
VrdE7'LANa DET�RMI1VATiON DATA Ft)RM — Eastern Mour�tains a�d Piec�rr�ont
Pra�ect,'Site: - GitylCoun�y: Sam�forog Ciate:
App4icanUQwner: State: Sampling Pcrint: ,
Investi�stzrr(s); SecGon, Tawrrship. Range: ~ -
Landform {hiY�skope, terrace, etc.j: `-, Laca! relie# (cancave, conrrex, e�one): Slop�: (°lcj:
, �
Subregipn (LRR or i�+l'LRAj , Laf: _- 4-ong: �' - Datum. , _ Y
SoiV Map Unit Name: _ N+�i classification: - -
F,re cl6matic f hydrologic conditions on th:e si#e Zypical #or this time of y�ar7 Yes No {Ef no, explain in �ermarks.y
Are V�gefation . Soif , ar Hydrology sign6�canrtiy disrturbed? Are °'Narmal Circumstances° presEnt7 Yes C�a
Are Vegeta�ian , 5oil , nr Hydrology naturaliy prablerr�atic? (14 needeci, expiain any answers in Remarks.j
SUMMARY tC�F �IN[31NGS - Attach �i�e map shawing sarnpling pc�irtt Icsca4ions, transects, impartant f�atures, etc.
Hydrophytic Vegetatian Present? Yes �a ��, �he Samp�ed Area
Hydric SoAf Pre�ent? Yes �o wsthin a WVtet9and? Yes '>� No
WVetlanc4 HydrQlogq PresenY7 Yes f�a -
_„ � _�;: , -
, -i , + . -� = d _,�r _ y
;
a"• -� -��, �
HYDROLOGY
Wetland iiydralagy Ind��ators: Seconda lndacators mini�r-uum o4 hva re uired
Prima Indica4mrs {minimum o€ on� 9e reauired check a41 Yhat applv} � 5urfa� So�4 Cr�cks (�6}
Surface Water {A1 j _ 7rue Aquatic Plan#s (814) � SParsely VEgetated Cancave Surfa�e (�8)
�i�gh Watier 7a�le (A2y Kydrogen Sulfide �dor (Ctij _[7radnage Patfems ($1d)
Salur�tic�n (A3) �(�xidized Rhiaospheres an Llvir�g Roats (C3} ,_ Moss Tram Lines (B16}
� Water Marks (�1 } _ Presenee oi Reduced Yrorr (C4} ,� Dey-5eason Water Tabie {C2)
� 8�diment Deposits {B2) � Rec.�n4 Iron Reduction in Til�ed Soils (�E) � Cra�sh Burrows {C8}
I7rifit Deposits (B�) _ Thin Niuck Sur#ace (C7) _ Saturation Visi�le an Aerial hmagery (C9}
� Algal Mat or Ceusl (B4} , C3ther (!Exp�ain i� Remarks} 0 SUsnted vr Stress�d PYants (D1)
0 Iran Qeposits (B5) _ Geomorphie Posilian {a2)
lnundation Visi6le on Aerial Imagery (�7} � ShaVlow Aquitard (D3)
P 1Nater-Stained Leaves (B9) : Microto�ographic Reii�f (L74}
_ Aquatic �auna {B13} � �AC-�leutraV Test (D�}
�ie�d Observations:
Surf�ce 4N�ter Present? Yes No � �epth (inches):
Water�able Presenf� Yes ` �o Depth (inches)
Saturation Present7 Yes _ " �+lo depth (inches)'
Wetland Hydralogy Present? Yes � ��
includes ca i11a frin �
D�sceibe Fiecorded Data {stream gaug�, manitoring well, a�rial phvtos, preuious inspections}, 1f avaiEable:
Remwarlcs:
EJS Arrny Carps �f �ng,ineers �aster� f+liauntaons and Piedmont- Interdm Version

L����+�1
'4+'EGETATIfJI+I (�t�ur Str�t�} — Use sciell�i�C n�mes of plat�ts. Sampiing ��Rnt '� `=L �
A�salute �aminant lndieatar Uoerrdnance test wvrksheet:
Tree Stratum Plat siz�° ) %�oves Speci��? Stazus ,fi
� N�mber of Clominant Species r_
1, „ �,, � , ' �-- �haf �re OBL, �AGUV, or FAC: �� (A)
� , . �.. � .. . . r ,. � _ . ., - .
2. - - TotaE Numbe� of paminant �
3. Sp�cies Accflss All Strata: (�}
q`. Percent af Dominamt 5pecies .�
�, That AP€� �BL, FACW, ar FAC; '� �'�'� {AF�}
5.
�PrevaCance fe�dex works�reet:
7. -
Til#al % C€7ver t3f'. Mu4ti d t5 :
8.
48L species x 1 �
, - � 4�' = Tot�l C6ver
Saolma/5hrub Stratum
( at size } � ., f F+4CVIf species x 2=
i. _ � , ' �� c �d � y r,� u�� FP�C �pecies x 3 = -
2. _ FACI� spec+es x 4=
�, UPL species x 5 =
� Ga9unnn Totals: [A) (�}
5• - Prevaler�ce fndex = �A �
6.
liydraphytic Vegetatiora fndicators•.
�. - - 1 - Rap�d_T�si for Hyci�ophytic'Vegefatiors
8. �-�2 - Dominance Test is �5fl°in -'
�, _ 3 - P�evalerrr�-��iex-�s �3:0,
r
1�. , r� ` 4- Mnrphafogicaf Adaptations' (Prov�de suy�portin�
_ = Ttitai Cover data in Rema�ks crr az� � separate sheet�
Herb lratum ��'tot s�ze. �` } 7 � `!� ,�-��� � — �'robleanatic Hydropt�ytic Veg�tatiar�' (Explaun}
1, r' � '�'� , v.., -�,, � = _ _
2. � ' _' `d �h�f `�" y
, lndicators of hydruc soul and wetrland hydrology ma�st
� be present, un9ess disturbed or peoblematic.
q. [�efiniti�v�ss of Four Vegetaiion Strata:
5. Tr�e - W�odY pla�ats, exclud�ng uines, 3 qn, {7.B cm) ar
6. rnore rn d'uameter a4 breast height ([3BH), regar�i➢e�s vf
7. h2tgt�t.
8. Sapl�ngfShrub - Wocrdy pi�nts, exduding vin�es, less
9. th�n 3 in. tiBFi and greater thair 3.28 �t {1 m} tatlV.
��1, Herb - Ald herb�ceaus (nRrr-woody) plants, rega�d�ess
1.�. oi size, and woody plants I�ss than 3.28 ft ta9l.
��• �111toody vine � AIB wpady vin�s greater t�an 3.28 � in
� Total Cq�� heic�ht.
Woodv yirae Straium (Pfpt si�e: s l
� I , �._ ,� -:_
2.
3.
�. -
6.
(inGiude photo ntnmk��rs here ar an a
US A�arry Gorps vf �nffineers
r� �� � ��� �
F �:� =1"otal Gawar
sheet,)
I Hydrophytic
h Vegetatian
� Pr�scn�?
,,� '
Ve;� -' ��
Eastern Nlnuntains and Piedmont � 1nier�rrr Version

SOI�
_ �
Samp3ia�g E�oint:
Prafike D�scription: (D�scri�� t� the d'epih �eeded to d�acument the tndica#or ror con#irnre the absence nf indicataos.)
Depth �l�t�ix Fiedax Features
inches Calor fmois,tJ °F� Cal�,r fmoisil % TVPe� �oc Texfure �temarlcs
�
, .. _
�,�- �- - ._ �� ..`fi �� i- _ _� 7 - � � . -' �_.��_.,x,'i�-.
. ,
r ._ � , � _
�. �„ / E ✓ w: ' ,. � � � � �
= . - �� �- � . .
�
Hydric Soit Irrdic�tor5:
HisfoSa9 (A1}
�iistic �pipeclon (A2}
� Black Hostic {A3}
: 'Hydre�gen SuYfide (A4�
5'tratif�ed L�y�rs (A5}
� 2 cm M1/�uck (A10} {LRFt Nj
� Depleted Be9aw aark SurEace (A11}
� Thic9c q2rk Surt�ace {Al2j
S�ndy �Iucky Mineral (S1} {LRli Ri„
4�il.RA ti47, 148)
Sandy Gteyed M�trix (S4}
~ Sarndy F2edox (S5�
St�'ipped Nlatrix {S�j
Rsstr➢�ctive Layer {uf �las�rveci}:
Type:
L]ep4h (inct�esj:
Remarks:
ZLn�atioet: �L=Ps�re Lir�irtq, Nd=�Natrix.
Indicators far Problematic Nydric So
i Dark Sur�Bce �57�
_ �'t�9y+,ralue Bepow surface {S8J (nn4.Ei�41�47, 1a8}
'Chin Park Sutface [59) �M�.RA 147, 'V48}
_ Loamy Gleye�i Matrix (�2}
� DepGeted Matrzx �'F3p
Redax �arls SurFace �'��6) ,
�, "�3ep6eted '�ark Sur�ace (F7}
� Redc�x ��presskans ��8)
i {ron-Manganese Masses {F12J (L6iti N,
I'N�RA �i36}
Urnbric5ur#ac� (�'V3) (fNLRA'&3�i, 122)
T puedmont Flmodplain Se�ils (F19) QMLRA 148j
! 2 cm I�'fiuek {A10} (NfLRA 147�
�oasY Prairie Redc�x {F,16j
^ �MLRA 14T, 1d8}
� Piedr�ont Ftaadplain Sviks {F18)
�MLRO! 136, 'k47}
Red Parent Materia� (�F2j
� Very S�Sail�w Dark Sur�ace (TF12)
� f7[her (�xplain in Remarks]
'Indicat�rs af hydrophytic vegetatuor� a�d
wetlarrd hydro6ogy must t�e pres�ni,
un1��s disturbed or problematic.
r'
Hydric Sa�il Prase�rt? Yes 1V�a
US Army �orps af �ngineers Eastern Mounta��ss and E'xedmont — Irrterian Vers'zo�

�� ��
. ,_,
W�TLAN!D [}ETERMINATIf3h� �1ATA �(}RM — Eastern Mount�ins �nd P�edm�rnt � �
ProjecUSite: . - � �" � CityFCountp; �amp9ing Date: —
Applicantf(7wner: 14`' State: SampEing �caint: `
Invesiigatar{sj: Sectian,'fownsfiip, Ra�ge:
Landform {hillsiope, terrace, etc.): Loeal relief (eoncave, convex, noney: Stcape (°Ja):
�i
5ubreginn (LRR or ivl�RA): L.at: - - Long: _ l7ata�m:
SoiY N�ap Unit Name: fi �+11NI classification: --
Are c9imafkc ! h�droloqie conditions an the sit� 4ypical for this time of year? Y�s No (9f na, exp[ai�r in Remasks.)
Are Vegetatimn , Soil , 4r Hydrplogy sign�cartt[y disturbed? Are "�ormal Circumstances'" presero3? Yes �iVa.
Are Vegetatian , So61 , ar Hydroiogy nakurally problematic? (4i needed, explaim any answers in Rerriarks.}
SUMlhfIARY ()F flNpl'NGS — Att�ach site rr►ap shcawing samp{ing p+oi�� Ac�catic��s, trans+�cts, innpc�rtarst features, etc.
Hydrophytic Vegetation Presenf? Yes M1��
Nydric SoiE Present? r�s �Q
Wetland Hydralogy Presenti? Yes Na
ts the Sar�p6ed Area \
within a 4Yet��nd? Yes Nn �
HYDFtC)LC�GY
Wetl�nd Hydrvlogy GndiCators: Seconda Ind'icato�s m�nimum of iwo ee �ired
Prirrna 4ndicatoes minlmum nf on is re uired check a61 that a I � Surface Soil Gracks (86�
Surface'Water {A1 j _ True A.quatic Plar�ts (61�) � Sparsely Vege4ated Conca+� Ssarface (B8}
libgh Water Tatsle (A2) , HYdragen Sul�i�e O�!or (Ci� , Dra�nag� Pat4ems {B3Q)
� Saturatiorr (A.3} _ Or�wdized Rhizospheres on �uvirv� Roots (C3} .� NEoss Z�im Lines (�16)
' 1Nater Marks {B1) ! Fresanee of Reduc�d Irvn (C4) , 6?ry-Seaso�n Waler �abYe �C2)
� Sederner�t �eposits (B2j _ Rec�nt 6ron Reduckion in Tilled Soils (C6) _ Crayfish e�ur�ows {�8j
� Cirift C?eposiis (�3) _ Thin Muck Surface {C7} s Sat�nra#lon U'isibl� on AeriaY Im�gery {�9}
I AIga1 C�riat or Ctust {�4j ^�ther (�xplain in Remarks� � St�nte�i Qr SUessed Plants {a'E)
' Iron Depasiis (B5) � Geamvrphec Pos+tior� (�?2)
` Inundati�an Visib�e �rn Aerial Imagery {B7j � Shal�aw At�uitard {i33}
� Water-Stained Leaves {B9) ^ Microtopog�aphic Relief (�74)
FAC-�leutral Tesk (D5)
! Aquat7c Fauna {�13) �
Field i�bservatiorrs:
Surfaoe Wa��r Present? Yes No Dep#h (incnes);
Wster Table PresenYt Yes No Depth {inches):
Saturation Present� Yes No Deptfl (inches}: Wetland Hydr�olagy Present? Ya� No
in��ludss Ca itfa fnn e
Describe Ftecorded Data {stream gauge, manitoring wel1, aeriat pho4os, previpus znspecGions}, if a�railatale:
Fterroa�lcs:
4�S Army Corps af �srgineePs Eastern ivnountains and Piedmont— Intencn versGon

VEGE7A"iION {Four Strata} — Use scienti�c names af piants.
. Absol�ate Dnmanant �npocatar
T�ee Stratwm (F�Irat size: -� ) °!� Cover ��pe� Status
r, � - J r �' �� �
2. p` y` �} -� �'� `"—
3. ?'t i 4� `� `� `' :'� i �1' R,+ � "� ' �' ° '"�' � '��I `
��+�`-��''�"��
� .,{
SampVing b�a%nt: �
Dpminartce 7 E:,t womsnesz;
h�umber ai dcamir�anf Species ``,
That Are fJBL FACV^J, ar FAC: (�}
�6o4a1 Number of [7om�nant
Sp�c'ses :Acrvss A�i Stea4a. � _ (�)
'�� _ � Rerc:�rut of [7�minant Species � �'
5. —
fi.
a.
8.
��' = Total �over
SaolinwlShrub Skeatu� {Plot size: ) �
<'"'{�` �, 1"s it�-�..
�. , , . f ��� �.t
3.
4.
5.
6.
7,
8.
9.
10. ��
� �-! R ��� = Total C�ve�
Herb Siraturv� (P4ot size: 1 _ _ �
i
� �
, , ,, C_
�{ . t d
1. -1 d' �.�' + : 9 � _: .
�. � . .. p ..-. y, P .. ... � � �.r"1'. °�r-��+7
+�. �!.'� �M�'. U'�. w-� -
� �� � � �� I
3.
i �., � = � � f'�>�
12.
r
Woadv Vins Skraturrr (f'Iat size: � i
I i.
Rer�a�ks; {ir+clude photcr
� �ry =Tr�t�lCover
= Total Gorrer
here or on a s�parate sheei.�
That Rre GBL, FACW, ar FA�: '.� —' (AI8}
Prsvalerac� index worksheet:
�otal °% Caver of: h+�uitiplv bv:
�DBL speci�s x 1 �
FA�'W ap�aes x 2 =
FAC species x 3 =
FACU speeies � 4 =
11PL species x 5 =
Column �`otaPs: 4�i ���
F�ravslence Index = BIA. =
�ydrophycic Yegetafion Indicatars:
� ti - Rapid Test.69f��!iiG Vegetetion
�'` 2 - Dominance Test is �5U'/a,E'
�
-- 3 - F'revalence-Index is z3.Q,
� 4 - hM1orphoiogieal Aciaptaivar�s' �Prowide suppotfing
� da�.a in Remarks or an � separate street}
^ Prtibl�cnai?e Hydrmphyt+c VegetatAon' (Explain}
'Indica#oss of hy�rlc sail and wetfand hydrt�logy anust
be present, un6ess siisturbed o� prable�atic.
D�Ei�i4aor�� �f Four V'�getatian Str�ta:
Tree — W�ady �al�nis, �xclud�ng vlrres, 3 in. [7;6 cm) nr
mcrre in diamefer at bneas# tteight {D��I), �eg�rdless of
h��ght.
Saplingl5hrula — Woody p9antis, exc4uding vines, tess
than 3 in, DBH �nd greater than 3.28 �t �1 ni} tall.
Herb — A1f herbaceous {non-wa�siy} Plar�ts, reg�rdless
af size. and waady p�ants less fhan 3,28' ft kafY.
Woody yine — Ail wvady +�ines greater than 3.2� ft in
heighk.
Hydro�nyc�C
ve�etation �`'
P�se�t'? 'f�s Nv
US Army Corps c�f Engineers
�astem !+�'aunfains and Piedrnar�� —1r�terirr� We�sican

S(]It
, , � � :� . ,. '�
Sartrplung Pairtt: �� ^���
Prnfiiie Gescription: (�escribe to Lh+e depth ne�ded to �kac�ernent the indicatar or caniirrn th� ahsence bf andicators.� -
�� tt� Ma3r�x R�dox Features
finch�s� Cal�rr mais °,� Cal�r {rnaistl °� 7Yue��� ._'fext�re Rama�rks
��r � � � `� � �'�, '"'�_�. -�---.� � - ; .
�
�
Hydric Sail indicators:
�Visinst�l �A1)
Hist�c Epipedarr (A2j
Bfaek tl�istic (A3)
� Hydeo�en Su1fid�; �A4}
5trafified Layers (�5)
r 2 cm Niuck (A1�1) (LF�R N)
� Cleplef�d Below Dark Suriace �A11}
� �'hick i�ar�C 5urtace {Al2]
� S�ndy Mucky �Uline�a� {�1 } (L'RR tJ,
M�RA 1+#7, 148)
Sandy G1eyed iv�2trix (S4j
� Sandy Redox (S�j
� Stri�ped M2trtx (S�i�
Restricti�re L�yer (if otssenredj:
Type:_
C7�pth finches}:
�emarks:.
-Redu�d Matrix, h14S-C�+lasked Sand Grains zLcrcatuon PL='Pore Lir�inq M=Matrix.
- Ind�caivts far Aro�teualatic iiydric Sails':
�ark 5urface {S7� � 2 Crrt Muck (A1 a} (fNLRA 1d7j
J Polyva6ue Below 5u'�'�ac.� �S8} dMLRA 147, 1d8j � Coast F'rairie 'Redflx 4/�16J
i ihFn �]aric Suriace (S9} (N1LRA 147, 14$J (#4'ILFtiA 147, 14&)
Loamy Gleye� N1atr6x (F2) i Pledm�nt F'I€aadpCain Sails (�F19)
, G�pEeted �rtatnx (F3) (i�iILRA 136, 14i}
Redvx Dark SurFace QF6} � Red P�rent Materiati {TF2)
� C7epletec€ Daric SsarfaGe ��i) � Very 5hallor� D�rk Surfa47e (fiF�2]
_ Redax t]epressians (F8j � fl#he� �Expl�in ir� Rerzaarksy
� 1roc�-Tw�anc�an�se Masses (F12) (LRR N,
NiLRA 136}
Unnbric SurF�ce QF13) (MLRaR 135, 122J 3Gndicziors of hydrophytic �e�getation and
� Piedrn+�nt Flvndplairt Sceils iF1�) �MLRA 1�8] wetl�nd hydrolagy mvst be preser�i,
— unless distur�aed or prablemalic.
HydriG Soi� Present7 Yss ��+`��
US Army Cc�rps �f Enc�gneers
�ast+em h+4ountains and �iedmont - Int�rim �lersion

C�i� �`�j4�
�r �-
_ 1� E ,� � i
W�TiAfV'� DETERMINATiO[V DATA F�f�M —�asiern Mountaan� and Piedmont
ProjectlSite � CitylCounty: S�mpling Date: .
ApplieanUOwner: -' � State: � SampGing F'oint:
Invest�gator(s): Section, Township, Range:
Lao�dfaem (b�illslape, kerrace, etc.}: Loeal relief (concave, convex, none): Slo�re {°fa):
Subregran (LRR or MLRA}: Lat: Lang: Datum:
Sobl Map Unit Name; �`' NWI ckassificatian: �
Are ciimatic ! hydrologic coRditions on the site typ6cal for th6s tlme of year? Yes _'' No (If no, ex�iladn in Remarks.}
Are Vegetation . Soil , or F�ydralagy significantly disturbed7 ;-' Are "Normal Circumstan�;s" present? Yes Nv
Are VegeRation . Sail , or Hydralogy naturally problematdc� (6f needed, �xp[ain any answers in Remarks.)
SUMMARY OF FINDEI�GS — Atiach site rnap shc�wi�rg sampling point locations, transects, impartant features„ etc.
Nydraphytic VegeRatian Present? Yes J� �fl Is the SampEed Area
Hydrlc Soil Present7 Yes � No withiro a Wetland? Yes Mo
Wet�and Hydrology Present? Yes No
I-{Yt3F.C]i_C�G1f
Wet4and Hydrology Indicators: Seconda Inddcators minirrrum of two r� u[red
Prima Indicators m�nimu�n of one is re uired� check all that a I � SurFacz SoiE Gracks (B6}
. Surface W�1er (A7 ) _ True Aquatic Piants (B14j _ Spaesely Vegetaked Conca�re Surface (88y
High Water 7able (A2} _ bydragen SulFide Odor (C1) _ Drainage Pattems (B1(l)
i Saturation (A3) _ Qxidized Rhizaspheres on Livinr� Roots �C3) _ Moss Tr4m L�nes (B16)
' Water Marks [81) _ Preserrce of Reduced lrorr (C4) ! Dry-Se�,son Water Table (C2}
Sediment Depos�ts (62) _ Ftecenk Iron 4�eduction in Ti11ed 5oils (C6) , Crayfish Burrows (CSj
� Dnft Deposits (63� _ Thin Muck Suriace (C7} � Satwra#lon Visible on AeriaV Imagery (�9j
� Algal Mlat or Crust {64} _ Oth�r (Explain ir� Remarks} _ Sdunted or Slressed Pkar�ts {D1J
lron Deposits {85} = Geomorphic 1�osition {D2)
� Inundalion Visihle on Aerial Irnagery (B7) _ 5ha11ow Aquitard (D3)
� Water-5tained Leaves (�9) � Mie�ofapagraphic Relief (C14j
� Aquatic Faun� f 8131 � FAGNeutral Test {D5)
Field f}bservatioers:
Surfa� Water Present? Yes �a Depth (lnches):
,
WaterTable Present? 4'es No Depih {inches}: ' -
Saturation Preseni? Yes No depth (inches}: Wet'land Hydrer4agy Present? Yes Nm
inc6udes ca illa frin e
Deseribe Recoeded Data (ste�am gauge, monitaring wekl, aerial pnotos, prevB�us inspectiorns}, if available�
Remarks:
US Army Carps of �ngineers Eastern Mountadns and Piedrnonk — �nterim Versian

V�G�TAT'If3N (Four Strata) - Use sci�ntific na�nes af plants.
' Absolute Clominanf Indicator
Tree Strat�m {Plot size: } °14 Cover Saeciea? Status
1. � - � � -
_ +%
2. r =? r "
3. # ; r.,.,; �� �- � � �,
�a `
4.
5.
8.
7,
n
5a[�iinqlSheu�a S#ratum (Plot size:
1.
2. � '
3.
4.
5.
6.
7.
8.
g
14.
� = TotaC CQ�er
}
�
�
- -i'� i
� �
+
`-'� = Totat Caver
Fter6 Siratum (Pla# size: �
1. - � -
2.
3.
4.
5.
5,
7. _
S. _
9. -
10,
11.
12.
_ �' {' = Totai Cover
Wood Vine Stratum {�'iat size: )
1.
2.
3.
4.
5.
fi.
= Todal CaueF
photo nurrabers here or on a ssparat�
����
5amplong Pair�t: 1'''�--` .
Dominan�e Tsst wr�rksheet:
Nurnber of C3ominant �pecies
Tk�at Are OB�. FAGW, or �AC: - _{A)
1'vtal Number of CJominant
Species Across All Sirata: {Bj
Percent ofi aamir�ant Species '
i�;r,��..:
That Ar� ���L, FACW, of FAC: � (PJ�)
Prer�alence index workshest:
Totia9 °/a Cover of: Multaplv bv:
CYB� speeies x 'G =
FACW s�ecies x 2 =
FAG species x 3 =
FACW species x 4 =
I.IPL species x 5 �
Golumr� Totals: {A) ($l
Preva�errce Index = B!A =
Hydrophytic Vegetat3on lndicatars:
�f - �tapid 7est fo� �Vydrophyta� Ve�etalian
'�2 - �ominan�e T�st 9s >5Q°!a-�
3- Prevalence index is s3.0"
_ 4 - Morpholvgical Adaptations' (Provide supporting
data in Reo�arks or on a separate shee#j
_ Prot�l�mat��c Hydrop�ytie Vegetalian' (Explain�
'Indicators of hyd�ic soii and w�:tfand hyd�ology rnus4
6� presen{, unless disturbed or prablematic.
Definitions of �our Wegetatian Strata:
Tree - Woady p��r�ls, excluding vines, 3 �n. (7.6 cm) oo�
more in d'oameter af br�ast V�eighd (�BH), regardl�ess of
he��ht.
5aplinglS�rub � V'v'oody �lants, excV�ding v�'rnes, less
lhan 3 iro. C3BH �nd greater than 3.28 ft(1 m) taVl.
kiert�-All hert�ac�ous {non-woody) plants, regardkess
vd size, ar�d womdy plan[s less ih�n 3.28 ft taVl.
Waody �ine - All woody vanes greater than 3.28 8 in
height.
Hydrophytic
Vegetation
Present� Yes � No
US Arro�y Corps of �ngirseer� €as4erri Mourutains arad Pa�dmanf - Interim Vers�on

af31L
��L-+if.�l�Z
Sampling P�rint: —
Profiie Qes�ription: �Qescribe to the depth rreeded to document the ind3cator �r confirm th� absence Qi ind�catcars.j
Depth Matrix 4��d�x Features
fi�chesl Co�ar fmoistj % CoNar (moist} °lo Tvne Lac Texture Rec��rks
`, _ � r
., . �
,
�� - - - -
; �� r
, _ C
� --
, r
'T e: C=Cer��en�ration, D=f3e leFfon, RM=Reduced Matr6x, MS=Masked 8and Gra6ns. �Locatian; PL=_Ppre Linin , M=Matrix.
Hyr�ric Scsil Inc�icators: Indicatars tor Problematic Wydric Sai[s':
Histosal {A1} _ 6ark SurFace yS7y � 2 cm Niuck (A1pj (M'LRA 747)
H�stic Epiped'an {A2j _ Polyvalue Be6ow Surface (S8) (MLRA 1&7, 148j _ Coasi Prairie Redox (Ai6} �
i Black Nistic (A3) _ Thin L7ark Surface (S9) (N1LRA 147, 148) (N�L�iA'f47, 148j
_ Hydrogsn Sulfide {A4) Loamy_Gleyed Matrix (�2j � Piedmont Floadplain S�ails (F15J
Stratifi�d Layers (A6} .;� DepVeted Matr�x {F�} ,' �MLRA 136, 147}
� 2 cm Muck {Ai p) (LRR hl) � f2edox Ciark��r�ace (�6) _ Red f�arent Rllateria4 [TF2}
�epieted Beiflw �ack Surfac� (A11 � ,J bephefed �ark SurEace (F7} _ Very Shafl�w QarK Sur�ac,e {7F12}
Thick Oa�k Surface (Al2� _ Redox Depressions (F8) � 04her (Exp[ain 1n Remarks)
� Sandy h+�ucky Mineral (51 j(LRR W, _ fron-Manganess Masses {F12} (LRR N„
INCRA 147, 148j NILRA 136j
5andy �leyed Matrix {�4) � lim�ric Surface (F13) {Tu'ILRA 136, 122j 3lndicatars a# hydraph}rtEc vegetatior� and
� S�nc7y Redox {S5) � Piedmorrt'Fkaodplain Soils {Fi 9) (AALFtA 148j we4land hydrology musi he preser�&,
� 5tripp�d Matrix (S6} unlass distur�ed or pr�b1ematic.
Restrictive Layer (if observed):
Type: }
C}epth {inahe�}: Hydri+c Sai4 Preserrt7 Yes � No
Remarics:
US Army Corps of Engirueers Eastem Nlountains and Piedi-u�ont – d¢�terirro Version

���
V�lETLAND DET�RNlVNr4TlQ1V DATA FORM —�astern Nlounta�ns and Piedmant ,
- ;;,� r �
ProjeeUSiYe: � f ' ' ` � , CitylCounty: � . 5amp[ing Cate � - ._
ApplicanUdwner: �" - State� � Sampliag Foint: 1'
Invesiogator{s}: SeC4ion, Township. Rar��e:
Landform (hills'lop�,, terrace, etc.J: Local relief (coracave, con++ex,.non�" Sgope (°�6): �-
—� - �
, , - _ [7atum. .';!
Subregion (LRR or MLRA). „ _ �at: � Lang: - � J
Sai1 M�p Unik Name: .�� - - NW"JI class4�ication:
Are clirnatic 1 hydrolagic conditior�s on the site typ'real for this tirme of year? Yes Na (If na, expl2in in Remarks.)
Are V'egetatian , Sail , or Hydrology sigr�ifican#ly desturbed? Are'°Nsrma! C�rc�smstances" present? Yes Na
Are Vegetation , Soil , ar Hydrology naluralfy probEemaiic? (1F needed, explain any answers in Fdemarks.}
SUMMARY C?F FIN�DINGS — Attach site rnap sho�ring samp4ing point locations, transec#s, import�nt iea�ures, etc,
Hydropriytic V'egetation Present?
Hydric Soi9 PresenC?
Wetland Hydrolcrgy Present?
Remarks:
F�YDRCiL�GY
Yes �'� No I� the Sampled Area �,,�
Yes �� =� witbin a Wetlanci? Yes �as '''�
Xes No �
Wetland 0lytirology Indicators: 5econda Indicafors ro�irud�urri of two re uired
Primary lndicat4rs Iminimum of one is reauired� check all i�hat apAlvl _ Surface 5ai7 Cracks (B6j
Surface Water {A1 j _�rue Aquatic Plants (B14) _ 5parsely Weget�ted Concave Surface (B8}
High Water Tab6e (A2) _ Hydrogen Sulfude Odor (C1j _ DrBi���e Pattems (B� Oj
5afuration (A3) � Cixid�zed Fthizaspheres on Living Roots (C3) , Moss Trim Lines {�1fi)
� Water Marks {B1} _ Presence of Reduc.�d IEon (C4} � Dry-5eas�n Water Table (C2}
Sediment Deposits {B2) _ Reeer�t Ir+aro Reduction in Tilled Sails [C6} � Cray�fish Burrows (C8)
C7rift Deposiis (B3) � Thin Muck SurFace (C7j _ Saturation Visibl� on Aerial Imagery [C8)
Algal Mat or Crust {B4) _ Other [Exphain in Remarks) ., Stunted ar St�essed Plants (D1 }
Iron Deposits (85} _ Ge9morphic Fositian ([72}
! 6nundatlon V�sible or� AeriaV Imagery {B7) _ Shallow Rquitard ([73}
� Water-Stain�d Leaves (69} _ Microtopographic Relief ([34}
� Aquatic Fauna (813} , FAGMeudral Test (D5)
Fiekd Ubservatians.
Surface Water F'resent? Yes GVw� bepth (inehes}:
WaterTable Present? Yes No Depth {inches):
Saturation Present? Yes IVm Depth (inches}: Wetland Hydrology Present? Yes No �``'�,
includes ca i1Na frin e
Describ� Recorded aata (strear� gauge, mondtoring well, aerial phatos, prev�dus inspections}, �i au�ailable:
Rernarks:
US Army Corps of €ngireeers Eastern Mountains and Piedmont - Interim Version

VEGETAT'IQ�d (F�ur Strata) � llse scientific names ofi plan�s.
_-� � ' Absnlute i�ornina
� ;h ,.� �t
Sampfi�g Fofnt �
Tree Straturn Plot size: �' } % Cover Soecies? Status
� Nurn�er of Daminant 8pecies
� � �'� r.'n � ThaC Are O�L, FACW. or �FAC:
L ` ' -" �—
z. ' _ - , �r;
Total Number oi Clominant
3, 5pecies Acra�s AA Strata:
4.
Pe�c�ent of [3ominant Species
5. Tha# Are OBL, FACW, or FAC:
6.
Prevalence I�adex worksheet:
7.
Tota� °/m Cover of� MultipfY bv:
8.
Sa lin iShrub Stratum {Plot size: }
L -
2 •
3.
4.
5.
6.
7.
8.
s.
10.
{Af8)
= Total Cover O�3L spec€es x 1= _
FAGW speeies x 2 =
�� •-- FAC species x 3 = _
FACU speCies x 4 =
IJPL species x 5 =
Ca9umn Totals: fA) (Bi
PrevalenCe Int�ex = �BfA =
Hydraphyrtic Vegetation Indicatars:
�- Rapid Test for Hydrophytic Vegetation
t'2 - Dominane� Test is �50%
3 _ 'Prevalence 6ndex is <3,�'
4 - M4ephological Adaptatipns� {Provide supportia�g
= Total Cover data in Remarks or on a separate sheetj
Nerb Stratum (Plot size: � ���� probiematic �6ydrophytic Vegetafsar�' (�xpladn)
1. r,^ � ( ) .:r �� . � , r:.., � � —
r.�;� �
�' � ��� � - 'Indicat�rs of nydeic soil arnd wetland hydrology must
3. be presen�, unless dislurk�ed �or �arbblematic.
4. �efin�tions of Faur 1lagetation Strata:
5.
Tree - Woody plar�ts, exclu�iing vin�s, 3 in. {7.6 �mj or
�• - rnare in diameter at hr�ast height (DSH), regardAess of
� height.
$� Saplingl5hrub - V+loody pVar�ts, excluding vin�s, less
g, than, 3 in. DB}i and greafer than 328 ft(1 m� tall.
9 Q.
Herb - All t�erbaceous (non-woodyj plants, regardRess
91. of size, and woody pVants less tharu 328 ft ta91.
12.
= Tota9 Cover �oody �ine - All wovdy vines greatsr than 3.28 ft i�u
- height.
UVoadv Vir�e Stra�um (I�lot size: - '=' )
+ �rr;1 ^�
1. t: r
2.
3.
4.
5.
6.
Rernarks:
numbe�rs here ar or� a separate
_ �,' ���',a',�-
�� � = Total Cover
Hydrophyt6c
1legeLa4ion
Present? Yes ' � No
US Army Corps gf �ngdneers Eastem IVlovntains and Piedmc�nt - Interim Vers'san

S�IL
����
Sampling Point; �'�,�/�ii� i � �, �i
Prcnfile Descripfio�o. (Describe to the depth needed ta dv�ument the indicatar vr cn�n4irm the absence of indicators.j
E?epth Matrix Redox Fea#ures
dinches) Color (moisi} _ /� Color maist °/a �ype Loc Texture Remarks
��, � �� � �^ r�� .' .. . -�. ' - � -- _ ����_ � � � , ..
/^�
d°^� i�7 ;, �r � _ _. � -- --�_ ���_ --- -_ � ✓ s� r�f -�� ,�y
`�" t _
'T e: C=Gon�ntratlon, �=De letion, �tN1=Retfuced Matrix, MS=i+�asked Sand Grains. 2Location: PL�Pore �inin , M=Matrix.
Hydric Sail Indicators: Indicators fos Problematic Hydric Soils':
HistosoV (A1 � _ Uark 5urface (87) _ 2 em fiVluck (A10} jMLRA 147)
Histic Epipedon (A2} _ Polyuafue Below SurFace (S�} (MLRA 147, f48j _ Cbasl Prairie �tedax (A16]
� Black l�dstic (A3) �, Thin Oark Surface [S9} (MLRA 147, 148) (MILRA �47, 1a8)
_ HydrQgen Sulfide {A4) _, Loamy C;leyed Matrix {F2) � P+�dmont Floodplain Sails (F19)
Stratified Layers (A5) _ pepleted Matrix (F3} (MLRA 436, 14T)
2 cm Cu1uc�C (A10) (LRR �Ij _ Redax 17ark Surface (�6) ! Red Parer�t Material (Tf2j
�epleted BeGaw Dark 5urface (A11 j � C7epleted dark Sur�ace {F7) , Very Sh�l1ow dark SurFace (TF12}
! Thick bsrk 5ur#aoe (Al2) � Redox Depressions (F8j _ Other (Expiairr in'Remarlcsj
! Sandy Niucky Mineral (S1} (LRR N, _ iron-Manganese Masses {F12j (LRR N,
NiLRA 14i, 148) MLRA 13�6}
Sandy Gleyed Matrix (S4) s U�rrbric Sur�ace (F13) (ML17A 't3S, 122) 3lndicators of hydrophytic aeget�tion and
S�rrdy Redax (S5j J P9edmont Flaodplain Soils (Fi9) {MLRA'E4$) wetland fi�ydrology must bs preseni,
Stripped Matrix {S6} unless dksturbed nr prohlematic.
Reslrictive Layer (if observ�d):
Type:
�
Deptfi� (inches): Hydric Soil Presemt? Yes No _
Remarks:
l�S Arrny Corps ot Engineers Eastern Maunta+ns and Piedmont — Interir� Wersion