20170783 Ver 1_Stream Assessment Forms_20170627

USACE AID#
DWQ#
Site # (indicate on attached map)
M _A4P
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name: Dominion North Carolina Power 2. Evaluator's name: Jonathan Connelly, Laura Clark
3. Date of evaluation: 2/16/17 4. Time of evaluation: 08:50 AM
5. Name of stream: LINT to Deep Creek 6. River basin: Tar -Pamlico
7. Approximate drainage area: 20 acres 8. Stream order: 2
9. Length of reach evaluated: 21 Oft 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): 36.124010 Longitude (ex. -77.556611): -77.439343
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
Located perpendicular to the survey corridor.
14. Proposed channel work (if any): N/A
15. Recent weather conditions: Yesterday morning/afternoon rain
16. Site conditions at time of visit: Undisturbed, adjacent to an agricultural field (cotton).
17. Identify any special waterway classifications known: Section 10 Tidal Waters _Essential Fisheries Habitat
Trout Waters . Outstanding Resource Waters Nutrient Sensitive Waters Water Supply Watershed _ .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' / If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' / 20. Does channel appear on USDA Soil Survey? *ES NO
21. Estimated watershed land use: % Residential % Commercial % Industrial 100 % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 1 Oft 23. Bank height (from bed to top of bank): 3ft
24. Channel slope down center of stream: _Flat (0 to 2%) _Gentle (2 to 4%) _Moderate (4 to 10%) X Steep (>10%)
25. Channel sinuosity: _ '/ Straight Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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): 28
Comments:
Evaluator's Signature Laura Clark Date 2/16/17
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
0
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
0
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
1
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
5
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
1
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
U
6
Presence of adjacent floodplain
0-4
0-4
0-2
0
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
0
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
6
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
0
(extensive channelization = 0; natural meander = max points)
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
NA
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0-5
0-4
0-5
y+
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0-5
0-5
0-5
3
a
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0-3
0-4
0-5
2
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
0
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
0
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
2
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
3
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
0
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = max points)
23
Evidence of wildlife use
0-6
0-5
0-5
1
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
28
* These characteristics are not assessed in coastal streams.

USACE AID#
DWQ#
Site # (indicate on attached map)
STREAM QUALITY ASSESSMENT WORKSHEET
AGO
Provide thefollowing information for the stream reach under assessment:
1. Applicant's name: Dominion North Carolina Power 2. Evaluator's name: Jonathan Connelly, Maggie Yayac
3. Date of evaluation: 02/09/2017 4. Time of evaluation: 3:30 PM
5. Name of stream: UNT to Deep Creek 6. River basin: Tar -Pamlico
7. Approximate drainage area: <5 acres 8. Stream order:
9. Length of reach evaluated: 0.22 mile 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.116305
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.416575
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
South of Edwards Fork Rd. Parallel to Shac008
14. Proposed channel work (if any):
15. Recent weather conditions: Light rain
16. Site conditions at time of visit: Sunny/Windy
17. Identify any special waterway classifications known:
Trout Waters . Outstanding Resource Waters
Section 10 Tidal Waters _Essential Fisheries Habitat
Nutrient Sensitive Waters Water Supply Watershed - .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' / If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' �f 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: % Residential % Commercial % Industrial 100 % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 4 23. Bank height (from bed to top of bank): 10
24. Channel slope down center of stream: _Flat (0 to 2%) _Gentle (2 to 4%) _Moderate (4 to 10%) X Steep (>10%)
25. Channel sinuosity: _ '/ Straight Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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): 36
Comments:
Evaluator's Signature Maggie Yayac Date 2/9/2017
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
0
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
0
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
3
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
0
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
1
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
U
6
Presence of adjacent floodplain
0-4
0-4
0-2
2
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
3
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
0
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
0
(extensive channelization = 0; natural meander = max points)
10
Sediment input
0-5
0-4
0-4
4
(extensive deposition= 0; little or no sediment = max points)
11
Size & diversity of channel bed substrate
NA*
0-4
0-5
NA
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0-5
0-4
0-5
5
y+
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0-5
0-5
0-5
0
a
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0-3
0-4
0-5
3
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
5
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
0
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
2
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
2
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
0
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = max points)
23
Evidence of wildlife use
0-6
0-5
0-5
6
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
36
* These characteristics are not assessed in coastal streams.

USACE AID#
DWQ#
Site # (indicate on attached map)
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment: AQP
1. Applicant's name: Dominion North Carolina Power 2. Evaluator's name: Jonathan Connelly, Maggie Yayac
3. Date of evaluation: 02/09/2017 4. Time of evaluation: 3:00 PM
5. Name of stream: UNT to Deep Creek 6. River basin: Tar -Pamlico
7. Approximate drainage area: <5 acres 8. Stream order:
9. Length of reach evaluated: 0.22 mile 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.116330
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.416678
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
South of Edwards Fork Rd. Parallel to Shac009
14. Proposed channel work (if any):
15. Recent weather conditions: Light rain
16. Site conditions at time of visit: Sunny/Windy
17. Identify any special waterway classifications known:
Trout Waters . Outstanding Resource Waters
Section 10 Tidal Waters _Essential Fisheries Habitat
Nutrient Sensitive Waters Water Supply Watershed - .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' / If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' �f 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: % Residential % Commercial % Industrial 100 % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 4 23. Bank height (from bed to top of bank): 10
24. Channel slope down center of stream: _Flat (0 to 2%) _Gentle (2 to 4%) _Moderate (4 to 10%) X Steep (>10%)
25. Channel sinuosity: _ '/ Straight Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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): 36
Comments:
Evaluator's Signature Maggie Yayac Date 2/9/2017
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
0
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
0
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
3
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
0
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
1
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
U
6
Presence of adjacent floodplain
0-4
0-4
0-2
2
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
3
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
0
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
0
(extensive channelization = 0; natural meander = max points)
10
Sediment input
0-5
0-4
0-4
4
(extensive deposition= 0; little or no sediment = max points)
11
Size & diversity of channel bed substrate
NA*
0-4
0-5
NA
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0-5
0-4
0-5
5
y+
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0-5
0-5
0-5
0
a
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0-3
0-4
0-5
3
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
5
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
0
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
2
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
2
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
0
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = max points)
23
Evidence of wildlife use
0-6
0-5
0-5
6
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
36
* These characteristics are not assessed in coastal streams.

USACE AID#
DWQ#
Site # (indicate on attached map)
STREAM QUALITY ASSESSMENT WORKSHEET -
Provide thefollowing information for the stream reach under assessment:
1. Applicant's name: Dominion North Carolina Power 2. Evaluator's name: Jonathan Connelly, Maggie Yayac
3. Date of evaluation: 2/07/17 4. Time of evaluation: 12:00 PM
5. Name of stream: Unnamed Tributary to Kehukee Swamp 6. River basin: Tar -Pamlico
7. Approximate drainage area: 5 acres 8. Stream order:
9. Length of reach evaluated: 200ft 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.121294402
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.417925478
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
Parallel to Railroad Street and the centerline within a forested upland
14. Proposed channel work (if any): N/A
15. Recent weather conditions: Sunny
16. Site conditions at time of visit: Undisturbed within a forested upland
17. Identify any special waterway classifications known: Section 10 Tidal Waters _Essential Fisheries Habitat
Trout Waters . Outstanding Resource Waters Nutrient Sensitive Waters Water Supply Watershed _ .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' / If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' �f 20. Does channel appear on USDA Soil Survey? YES ko
21. Estimated watershed land use: 25 % Residential % Commercial % Industrial % Agricultural
% Forested 50 % Cleared / Logged 25 % Other ( Substation )
22. Bankfull width: 3 23. Bank height (from bed to top of bank). 6 inches
24. Channel slope down center of stream: _Flat (0 to 2%) 4 Gentle (2 to 4%) _Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: _ Straight '0' Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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 feature name - shac001; located within a forested upland
plant community, species include individuals of loblolly pine, sweet gum, greenbriar, willow oak in the canopy
Evaluator's Signature Date 2/07/17
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
0
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
6
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
55
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
5
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
0
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
U
6
Presence of adjacent floodplain
0-4
0-4
0-2
0
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
2
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
0
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
4
(extensive channelization = 0; natural meander = max points)
10
Sediment input
0-5
0-4
0-4
0
(extensive deposition= 0; little or no sediment = max points)
11
Size & diversity of channel bed substrate
NA*
0-4
0-5
NA
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0-5
0-4
0-5
5
y+
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0-5
0-5
0-5
5
a
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0-3
0-4
0-5
2
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
5
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
0
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
5
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
5
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
0
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = 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 first page)
551
* These characteristics are not assessed in coastal streams.

/ sh as
USACE AID# DWQ # Site # (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET -
Provide the following information for the stream reach under assessment:
1. Applicant's name: ��1� y���a�` 2. Evaluator's name:..
3. Date of evaluation: W / 4. Time of evaluation:
5. Name of stream: A1 6. River basin:
7. Approximate drainage area: �� 8. Stream order:
9. Length of reach evaluated: 4" 10. County:
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
/ / / o
Latitude (ex. 34.872312): 3G , 71c —/ Longitude (ex. –77.556611):
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
0/c/ vi—Illyd
14. Proposed channel work (if any):
15. Recent weather conditions:
16. Site conditions at time of
17. Identify any special waterway classifications known: _Section 10 _Tidal Waters Essential Fisheries Habitat
_Trout Waters Outstanding_ Resource Waters Nutrient Sensitive Waters -Water Supply Watershed (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES N If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? S NO 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: _% Residential % Commercial _% Industrial 111% Agricultural
Forested % Cleared/ Logged % Other
22. Bankfull width: ,� 23. Bank height (from bed to top of bank):
24. Channel slope down center of stream: v�Flat (0 to 2%) _Gentle (2 to 4%) _Moderate (4 to 10%) _Steep (>101/o)
25. Channel sinuosity: Straight� `Occasional bends Frequent meander _very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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): 1
Evaluator's Signature "�E'—' /' t ;°'r Date Z,+'f
This channel evaluation form is intended �to be uss only as a guide to assist landowners and Knvir�odmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change - version 06/03. To Comment, please call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
2
3

'54)aea
USACE AID# DWQ # Site # (indicate on attached map)
M
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name: m ® 6-y &
//
3. Date of evaluation: V/
S. Name of stream:
7. Approximate drainage area: z"r erez
0
9. Length of reach evaluated: �(% r
2. Evaluator's name:_,/i%���i%�
4. Time of evaluation: �®
6. River basin:
,Vv 14-111
/ �
8. Stream order: � n I& fi� vt � j� u1
10. County: l�
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
'36
Latitude (ex. 34.872312): , 16 '7111 Longitude (ex. -77.556611): — Z7/ .o �9
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
0t) DA. fCe/ filo , - 00 -hs -qO1 /, 0� %// /i /- _✓
14. Proposed chann
15. Recent weather
16. Site conditions at time of visit: a 61 / /1'/ 0, /
17. Identify any special waterway classifications known: _Section 10 _Tidal Waters Essential Fisheries Habitat
-- _Trout Waters _Outstanding Resource Waters Nutrient Sensitive Waters -_Water Supply Watershed --- --(I-IV)-
18. Is there a pond or lake located upstream of the evaluation point? YES (i§)If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? YE NO 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: % Residential % Commercial % Industrial % Agricultural
/ % Forested % Cleared / Logged % Other ( /
22. Bankfull width: 23. Bank height (from bed to top of bank):
24. Channel slope down center of stream: Flat (0 to 2%) _�,i entle (2 to 4%) _Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: StraightOccasional bends _Frequent meander _Very sinuous _Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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): /7Y Comments:
Evaluator's Signature Date W/ 111411a,14117
This channel evaluation fo in is intended to be a Wd only as a guide to assist landowners and nvironmental professionals in
gathering the data required by the United Sta es Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change — version 06/03. To Comment, please call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET LJ�
* These characteristics are not assessed in coastal streams.
2
RON
0
0

USACE AID#
DWQ#
Site # (indicate on attached map)
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment: AQP
1. Applicant's name: Dominion North Carolina Power 2. Evaluator's name: Jonathan Connelly, Maggie Yayac
3. Date of evaluation: 02/10/2017 4. Time of evaluation: 11:30 AM
5. Name of stream: UNT to Deep Creek 6. River basin: Tar -Pamlico
7. Approximate drainage area: <5 acres 8. Stream order: 0
9. Length of reach evaluated: 470ft 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.114018
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.416098
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
East of Rt 125, south of Scotland Neck Substation
14. Proposed channel work (if any):
15. Recent weather conditions: High Winds
16. Site conditions at time of visit: Sunny, Cold
17. Identify any special waterway classifications known:
Trout Waters . Outstanding Resource Waters
Section 10 Tidal Waters _Essential Fisheries Habitat
Nutrient Sensitive Waters Water Supply Watershed _ .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' / If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? �f 20. Does channel appear on USDA Soil Survey? YES )NO
21. Estimated watershed land use: % Residential % Commercial % Industrial 100 % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 3ft 23. Bank height (from bed to top of bank): 2ft
24. Channel slope down center of stream: X 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 worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 33
Comments: In an agricultural field, parallels shac010 swale
Evaluator's Signature Maggie Yayac Date 02/10/2017
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
0
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
6
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
1
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
5
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
2
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
U
6
Presence of adjacent floodplain
0-4
0-4
0-2
0
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
2
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
0
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
0
(extensive channelization = 0; natural meander = max points)
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
NA
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0-5
0-4
0-5
5
y+
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0-5
0-5
0-5
5
a
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0-3
0-4
0-5
0
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
5
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
0
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
0
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
0
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
0
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = max points)
23
Evidence of wildlife use
0-6
0-5
0-5
0
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
33
* These characteristics are not assessed in coastal streams.

USACE AID#
DWQ#
Site # (indicate on attached map)
M
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the followin _ information for the stream reach under assessment:
1. Applicant's name: 064 1 f r 2. Evaluator's name:{{
3. Date of evaluation: 2 4. Time of evaluation: A'a
S. Name of stream: 6. River basin:
7. Approximate drainage area: l -e1 8. Stream order:
9. Length of reach evaluated: /012 / 10. County:
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any): �J / /
Latitude (ex. 34.872312): 3 11001 Longitude (ex. —77.556611): / i "%3c2 7oO
Method location determined (circle):C�ps)((r
Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluote nearby roads and landmarks and attach map identifying stream(s) location):
fl f_�iR �l n 1 nl ✓i /l,A✓
14. Proposed channel work (if any):
15. Recent weather conditions: o re a � /
16. Site conditions at time of visit: /) 0 /A4/
17. Identify any special waterway classifications known: _Section 10 _Tidal Waters _Essential Fisheries Habitat
_Trout Waters Outstanding Resource Waters _ Nutrient Sensitive Waters _Water Supply Watershed (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES NO If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? YES NO 20. Does channel appear on USDA Soil Survey? `YES O
21. Estimated watershed land use: /° Residential % Commercial % Industrial % Agricultural
Forested % Cleared / Logged % Other ( )
22. Bankfull width: 23. Bank height (from bed to top of bank): L
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 Y11 Occasional bends Frequent meander _Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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:
Evaluator's Signature1_1 %l < ° ;L421 Date 1,52/, -5,f``�
This channel evaluationibrin is intended to be,used only as a guide to assist landowners and eiroii`mental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change - version 06/03. To Comment, please call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET .�A 44 #y—
M
c)"
E
* These characteristics are not assessed in coastal streams.

USACE AID#
DWQ # Site # (indicate on attached map)
M
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name: 0Ac+11ll Novi �1f 1011 A 2. Evaluator's name: iof "
3. Date of evaluation: -� (�7 4. Time of evaluation: ® /
5. Name of stream: 6. River basin: V l
�F
7. Approximate drainage area: 1� 41 ,� z l 8. Stream order: `� / VI"
/."
9. Length of reach evaluated: /�d� 10. County:
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): —,t, Il Longitude (ex. —77.556611): — %, 11/4
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation note nearby roads and landmarks and attach map identifying stream(s) location):
14. Proposed channel work (if any):
15. Recent weather condition
16. Site conditions at time of
17. Identify any special waterway classifications known: _Section 10 Tidal Waters _Essential Fisheries Habitat
_Trout Waters _Outstanding Resource Waters -_Nutrient Sensitive Waters --_Water Supply Watershed----- (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? YES o If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? YES Q 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: % Residential % Commercial _% Industrial % Agricultural
Forested % Cleared / Logged % Other ( )
22. Bankfull width: 23. Bank height (from bed to top of bank):
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 worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality. /
Total Score (from reverse): D Comments:
Evaluator's Signature Dated
This channel evaluatio form is intende to be used duly my as a guide to assist landowners and ehviro . ental professionals in
gathering the data required by the United States. Qy Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change — version 06/03. To Comment, please call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET f 6 ,,, '
* These characteristics are not assessed in coastal streams.
2
0
i
Ij

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: Dominion North Carolina Power 2. Evaluator's name: LC, MW
3. Date of evaluation: 5/11/17 4. Time of evaluation: 9:40am
5. Name of stream: shaw002 6. River basin: Tar/Pamlico
7. Approximate drainage area: 8 acres 8. Stream order: 1
9. Length of reach evaluated: 76.8 feet 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.162297
12. Subdivision name (if any): N/A
Longitude (ex. -77.556611): -77.497084
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
South East of the intersection of Bynums Bridge Road and Rt 903/125
14. Proposed channel work (if any): N/A
15. Recent weather conditions: Cloudy
16. Site conditions at time of visit: Cloudy
17. Identify any special waterway classifications known:
Trout Waters . Outstanding Resource Waters
Section 10 Tidal Waters _Essential Fisheries Habitat
Nutrient Sensitive Waters Water Supply Watershed _ (I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' / If yes, estimate the water surface area: 2.5 acres
19. Does channel appear on USGS quad map? ' �f 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: 5 % Residential % Commercial % Industrial 60 % Agricultural
30 % Forested 5 % Cleared / Logged % Other ( )
22. Bankfull width: 6ft 23. Bank height (from bed to top of bank): 4ft
24. Channel slope down center of stream: _Flat (0 to 2%) X Gentle (2 to 4%) _Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: _ Straight '( Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a 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:
Evaluator's Signature Date 05/11/2017
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
3
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
1
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
0
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
4
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
2
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
U
6
Presence of adjacent floodplain
0-4
0-4
0-2
0
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
0
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
0
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
1
(extensive channelization = 0; natural meander = max points)
10
Sediment input
0-5
0-4
0-4
4
(extensive deposition= 0; little or no sediment = max points)
11
Size & diversity of channel bed substrate
NA*
0-4
0-5
NA
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0-5
0-4
0-5
4
y+
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0-5
0-5
0-5
3
a
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0-3
0-4
0-5
2
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
0
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
1
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
3
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
0
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
1
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
1
(no evidence = 0; common, numerous types = 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 first page)
33
* These characteristics are not assessed in coastal streams.

Notes on Characteristics Identified in Assessment Worksheet
1. Consider channel flow with respect to channel cross-sectional area (expected flow), drainage area, recent precipitation, potential
drought conditions, surrounding land use, possible water withdrawals, presence of impoundments upstream, vegetation growth in
channel bottom (as indicator of intermittent flow), etc.
2. Human -caused alterations may include relocation, channelization, excavation, riprap, gabions, culverts, levees, berms, spoil piles
adjacent to channel, etc.
3. The riparian zone is the area of vegetated land along each side of a stream or river that includes, but is not limited to, the
floodplain. Evaluation should consider width of riparian area with respect to floodplain width, vegetation density, maturity of
canopy and understory, species variety, presence of undesirable invasive species (exotics), breaks (utility corridors, roads, etc.),
presence of drainage tiles, logging activities, other disturbances which negatively affect function of the riparian zone.
4. Evidence of nutrient or chemical discharges includes pipes, ditches, and direct draining from commercial and industrial sites,
agricultural fields, pastures, golf courses, swimming pools, roads, parking lots, etc. Sewage, chlorine, or other foul odors,
discolored water, suds, excessive algal growth may also provide evidence of discharge.
5. Groundwater discharge may be indicated by persistent pools and saturated soils during dry weather conditions, presence of
adjacent wetlands, seeps, and springs feeding channel, reduced soils in channel bottom.
6. Presence of floodplains may be determined by topography and the slope of the land adjacent to the stream, terracing, the extent of
development within the floodplain, FEMA designation if known, etc.
7. Indicators of floodplain access include sediment deposits, wrack lines, drainage patterns in floodplain, local stream gauge data,
testimony of local residents, entrenchment ratio, etc. Note that indicators may relic and not a result of regular flooding.
8. Wetland areas should be evaluated according to their location, size, quality, and adjacency relative to the stream channel, and
may be indicated by beaver activity, impounded or regularly saturated areas near the stream, previous delineations, National
Wetland Inventory maps, etc. (Wetlands must meet criteria outlined in 1987 delineation manual and are subject to USACE approval.)
9. Channel sinuosity should be evaluated with respect to the channel size and drainage area, valley slope, topography, etc.
10. To evaluate sediment deposition within the channel consider water turbidity, depth of sediment deposits forming at point bars and
in pools, evidence of eroding banks or other sediment sources within watershed (construction sites, ineffective erosion controls). In
rare cases, typically downstream of culverts or dams, a sediment deficit may exist and should be considered in scoring.
11. When looking at channel substrate, factor in parent material (presence of larger particles in soil horizons adjacent to the stream), average
size of substrate (bedrock, clay/silt, sand, gravel, cobble, boulder, etc.), and diversity of particle size (riprap is excluded).
12. Indications of channel incision and deepening may include a v -shaped channel bottom, collapsing banks, evidence of recent
development and increased impervious surface area resulting in greater runoff in the watershed.
13. Evaluation should consider presence of major bank failures along the entire reach under evaluation, including uprooted trees on
banks, banks falling into channel, formation of islands in channel as they widen, exposed soil, active zones of erosion, etc.
14. Increased root depth and density result in greater bank stability. Consider the depth and density that roots penetrate the bank
relative to the amount of exposed soil on the bank and the normal water elevation.
15. Assessment of agriculture, livestock, and/or timber production impacts should address areas of stream bank destabilization,
evidence of livestock in or crossing stream, loss of riparian zone to pasture or agricultural fields, evidence of sediment or high
nutrient levels entering streams, drainage ditches entering streams, loss of riparian zone due to logging, etc.
16. Riffle -pool steps can be identified by a series of alternating pools and riffles. Abundance, frequency, and relative depth of riffles
and pools should be considered with respect to topography (steepness of terrain) and local geology (type of substrate).
Coastal plain streams should be evaluated for the presence of ripple -pool sequences. Ripples are bed forms found in sand bed
streams with little or no gravel that form under low shear stress conditions, whereas, dunes and antidunes form under moderate
and high shear stresses, respectively. Dunes are the most common bed forms found in sand bed streams.
17. Habitat complexity is an overall evaluation of the variety and extent of in -stream and riparian habitat. Types of habitat to look
for include rocks/cobble, sticks and leafpacks, snags and logs in the stream, root mats, undercut banks, overhanging vegetation,
pool and riffle complexes, wetland pockets adjacent to channel, etc.
18. Evaluation should consider the shading effect that riparian vegetation will provide to the stream during the growing season. Full
sun should be considered worst case, while good canopy coverage with some light penetration is best case.
19. Stream embeddedness refers to the extent that sediment that has filled in gaps and openings around the rocks and cobble in the
streambed. The overall size of the average particle in the streambed should be considered (smaller rocks will have smaller gaps).
20. Evaluation should be based on evidence of stream invertebrates gathered from multiple habitats. Scores should reflect
abundance, taxa richness, and sensitivity of stream invertebrate types. (see attached examples of common stream invertebrates on page
4).
21. Evaluation should include evidence of amphibians in stream channel. Tadpoles and frogs should receive minimum value, while
salamanders, newts, etc. may be assigned higher value.
22. Evaluation of fish should consider the frequency and, if possible, the variety of different fish taxa observed.
23. Evaluation of wildlife should include direct observation or evidence (tracks, shells, droppings, burrows or dens, hunting stands, evidence
of fishing, etc.) of any animals using the streambed or riparian zone, to include small and large mammals, rodents, birds, reptiles,
insects, etc.

Common Stream Invertebrates
Sensitive Taxa — Pollution sensitive organisms that may be found in good quality water.
Caddisfly
Mayfly
Stonefly
Dobsonfly
Riffle Beetle
Water Penny
Gilled Snail
Somewhat Tolerant Taxa — Somewhat pollution tolerant organisms that may be found in good or
Beetle Larva
Clam
Crayfish Damselfly Nymph
Sowbug
Scud
Cranefly
N
Dragon Fly Nymph
Tolerant Taxa — Pollution tolerant organisms that may be found in anv quality water.
Blackfly Larva Leech Midge Fly Larva
,r
,r
R 1 .
Aquatic Worm Pouch & Pond Snail
4

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: Dominion North Carolina Power 2. Evaluator's name: LC, MW
3. Date of evaluation: 5/09/17 4. Time of evaluation: 3:00pm
5. Name of stream: shaw001 6. River basin: Tar/Pamlico
7. Approximate drainage area: 38 acres 8. Stream order: 2
9. Length of reach evaluated: -286 feet 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.109758
12. Subdivision name (if any): N/A
Longitude (ex. -77.556611): -77.425173
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
West of Rt 125 and South of Grasunan Rd.
14. Proposed channel work (if any): N/A
15. Recent weather conditions: Sunny
16. Site conditions at time of visit: Sunny
17. Identify any special waterway classifications known:
Trout Waters . Outstanding Resource Waters
Section 10 Tidal Waters _Essential Fisheries Habitat
Nutrient Sensitive Waters Water Supply Watershed - .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' J 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: 110 % Residential % Commercial % Industrial 50 % Agricultural
30 % Forested 110 % Cleared / Logged % Other ( )
22. Bankfull width: loft 23. Bank height (from bed to top of bank): 11 ft
24. Channel slope down center of stream: _Flat (0 to 2%) _Gentle (2 to 4%) _Moderate (4 to 10%) x Steep (>10%)
25. Channel sinuosity: _ Straight '0' Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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:
Evaluator's Signature Date 05/09/2017
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
3
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
2
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
2
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
5
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
3
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
U
6
Presence of adjacent floodplain
0-4
0-4
0-2
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
0
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
4
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
3
(extensive channelization = 0; natural meander = max points)
10
Sediment input
0-5
0-4
0-4
4
(extensive deposition= 0; little or no sediment = max points)
11
Size & diversity of channel bed substrate
NA*
0-4
0-5
NA
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0-5
0-4
0-5
0
y+
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0-5
0-5
0-5
2
a
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0-3
0-4
0-5
1
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
0
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
1
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
3
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
0
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
3
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
3
(no evidence = 0; common, numerous types = 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 first page)
43
* These characteristics are not assessed in coastal streams.

Notes on Characteristics Identified in Assessment Worksheet
1. Consider channel flow with respect to channel cross-sectional area (expected flow), drainage area, recent precipitation, potential
drought conditions, surrounding land use, possible water withdrawals, presence of impoundments upstream, vegetation growth in
channel bottom (as indicator of intermittent flow), etc.
2. Human -caused alterations may include relocation, channelization, excavation, riprap, gabions, culverts, levees, berms, spoil piles
adjacent to channel, etc.
3. The riparian zone is the area of vegetated land along each side of a stream or river that includes, but is not limited to, the
floodplain. Evaluation should consider width of riparian area with respect to floodplain width, vegetation density, maturity of
canopy and understory, species variety, presence of undesirable invasive species (exotics), breaks (utility corridors, roads, etc.),
presence of drainage tiles, logging activities, other disturbances which negatively affect function of the riparian zone.
4. Evidence of nutrient or chemical discharges includes pipes, ditches, and direct draining from commercial and industrial sites,
agricultural fields, pastures, golf courses, swimming pools, roads, parking lots, etc. Sewage, chlorine, or other foul odors,
discolored water, suds, excessive algal growth may also provide evidence of discharge.
5. Groundwater discharge may be indicated by persistent pools and saturated soils during dry weather conditions, presence of
adjacent wetlands, seeps, and springs feeding channel, reduced soils in channel bottom.
6. Presence of floodplains may be determined by topography and the slope of the land adjacent to the stream, terracing, the extent of
development within the floodplain, FEMA designation if known, etc.
7. Indicators of floodplain access include sediment deposits, wrack lines, drainage patterns in floodplain, local stream gauge data,
testimony of local residents, entrenchment ratio, etc. Note that indicators may relic and not a result of regular flooding.
8. Wetland areas should be evaluated according to their location, size, quality, and adjacency relative to the stream channel, and
may be indicated by beaver activity, impounded or regularly saturated areas near the stream, previous delineations, National
Wetland Inventory maps, etc. (Wetlands must meet criteria outlined in 1987 delineation manual and are subject to USACE approval.)
9. Channel sinuosity should be evaluated with respect to the channel size and drainage area, valley slope, topography, etc.
10. To evaluate sediment deposition within the channel consider water turbidity, depth of sediment deposits forming at point bars and
in pools, evidence of eroding banks or other sediment sources within watershed (construction sites, ineffective erosion controls). In
rare cases, typically downstream of culverts or dams, a sediment deficit may exist and should be considered in scoring.
11. When looking at channel substrate, factor in parent material (presence of larger particles in soil horizons adjacent to the stream), average
size of substrate (bedrock, clay/silt, sand, gravel, cobble, boulder, etc.), and diversity of particle size (riprap is excluded).
12. Indications of channel incision and deepening may include a v -shaped channel bottom, collapsing banks, evidence of recent
development and increased impervious surface area resulting in greater runoff in the watershed.
13. Evaluation should consider presence of major bank failures along the entire reach under evaluation, including uprooted trees on
banks, banks falling into channel, formation of islands in channel as they widen, exposed soil, active zones of erosion, etc.
14. Increased root depth and density result in greater bank stability. Consider the depth and density that roots penetrate the bank
relative to the amount of exposed soil on the bank and the normal water elevation.
15. Assessment of agriculture, livestock, and/or timber production impacts should address areas of stream bank destabilization,
evidence of livestock in or crossing stream, loss of riparian zone to pasture or agricultural fields, evidence of sediment or high
nutrient levels entering streams, drainage ditches entering streams, loss of riparian zone due to logging, etc.
16. Riffle -pool steps can be identified by a series of alternating pools and riffles. Abundance, frequency, and relative depth of riffles
and pools should be considered with respect to topography (steepness of terrain) and local geology (type of substrate).
Coastal plain streams should be evaluated for the presence of ripple -pool sequences. Ripples are bed forms found in sand bed
streams with little or no gravel that form under low shear stress conditions, whereas, dunes and antidunes form under moderate
and high shear stresses, respectively. Dunes are the most common bed forms found in sand bed streams.
17. Habitat complexity is an overall evaluation of the variety and extent of in -stream and riparian habitat. Types of habitat to look
for include rocks/cobble, sticks and leafpacks, snags and logs in the stream, root mats, undercut banks, overhanging vegetation,
pool and riffle complexes, wetland pockets adjacent to channel, etc.
18. Evaluation should consider the shading effect that riparian vegetation will provide to the stream during the growing season. Full
sun should be considered worst case, while good canopy coverage with some light penetration is best case.
19. Stream embeddedness refers to the extent that sediment that has filled in gaps and openings around the rocks and cobble in the
streambed. The overall size of the average particle in the streambed should be considered (smaller rocks will have smaller gaps).
20. Evaluation should be based on evidence of stream invertebrates gathered from multiple habitats. Scores should reflect
abundance, taxa richness, and sensitivity of stream invertebrate types. (see attached examples of common stream invertebrates on page
4).
21. Evaluation should include evidence of amphibians in stream channel. Tadpoles and frogs should receive minimum value, while
salamanders, newts, etc. may be assigned higher value.
22. Evaluation of fish should consider the frequency and, if possible, the variety of different fish taxa observed.
23. Evaluation of wildlife should include direct observation or evidence (tracks, shells, droppings, burrows or dens, hunting stands, evidence
of fishing, etc.) of any animals using the streambed or riparian zone, to include small and large mammals, rodents, birds, reptiles,
insects, etc.

Common Stream Invertebrates
Sensitive Taxa — Pollution sensitive organisms that may be found in good quality water.
Caddisfly
Mayfly
Stonefly
Dobsonfly
Riffle Beetle
Water Penny
Gilled Snail
Somewhat Tolerant Taxa — Somewhat pollution tolerant organisms that may be found in good or
Beetle Larva
Clam
Crayfish Damselfly Nymph
Sowbug
Scud
Cranefly
N
Dragon Fly Nymph
Tolerant Taxa — Pollution tolerant organisms that may be found in anv quality water.
Blackfly Larva Leech Midge Fly Larva
,r
,r
R 1 .
Aquatic Worm Pouch & Pond Snail
4

USACE AID#
DWQ#
Site # (indicate on attached map)
STREAM QUALITY ASSESSMENT WORKSHEET
Provide thefollowing information for the stream reach under assessment:
1. Applicant's name: Dominion North Carolina Power 2. Evaluator's name: Jaclyn Martin, Laura Clark
3. Date of evaluation: 3/15/17 4. Time of evaluation: 12:40 PM
5. Name of stream: UNT to Beech Swamp 6. River basin: Tar -Pamlico
7. Approximate drainage area: <5 acres 8. Stream order:
9. Length of reach evaluated: n/a 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.188989
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.564064
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
14. Proposed channel work (if any): N/A
15. Recent weather conditions: cloudy
16. Site conditions at time of visit: normal
17. Identify any special waterway classifications known:
Trout Waters . Outstanding Resource Waters
Section 10 Tidal Waters _Essential Fisheries Habitat
Nutrient Sensitive Waters Water Supply Watershed - .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' / If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' �f 20. Does channel appear on USDA Soil Survey? YES XNO
21. Estimated watershed land use: % Residential % Commercial % Industrial % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 5 23. Bank height (from bed to top of bank): 1
24. Channel slope down center of stream: _Flat (0 to 2%) X Gentle (2 to 4%) _Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: _ Straight '0' Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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): 27
Comments:
Evaluator's Signature Date 03/15/17
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
2
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
0
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
2
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
3
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
1
U(no
discharge = 0; springs, seeps, wetlands, etc. = max points)
6
Presence of adjacent floodplain
0-4
0-4
0-2
2
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
2
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
2
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
2
(extensive channelization = 0; natural meander = max points)
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
NA
(fine, homogenous = 0; large, 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)
E*Presence
13
of major bank failures
0-5
0-5
0-5
2
a
04
(severe erosion = 0; no erosion, stable banks = max points)
M
14
Root depth and density on banks
0-3
0-4
0-5
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
1
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
0
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
2
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
0
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = max points)
23
Evidence of wildlife use
0-6
0-5
0-5
0
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
27
* These characteristics are not assessed in coastal streams.

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: Dominion North Carolina Power 2. Evaluator's name: LC, JC
3. Date of evaluation: 4/26/17 4. Time of evaluation: 9:30am
5. Name of stream: shac035 - UNT to Beech Swamp 6. River basin: Tar -Pamlico
7. Approximate drainage area: 7 acres 8. Stream order:
9. Length of reach evaluated: 204 ft 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.20391
12. Subdivision name (if any): N/A
Longitude (ex. -77.556611): -77.605915
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
14. Proposed channel work (if any): N/A
15. Recent weather conditions: sunny
16. Site conditions at time of visit: flooded from heavy rain
17. Identify any special waterway classifications known:
Trout Waters . Outstanding Resource Waters
Section 10 Tidal Waters _Essential Fisheries Habitat
Nutrient Sensitive Waters Water Supply Watershed - .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' �f 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: % Residential % Commercial % Industrial 70 % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 2ft 23. Bank height (from bed to top of bank):.25ft
24. Channel slope down center of stream: X 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 worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., the stream flows from a pasture
into a forest), the stream may be divided into smaller reaches that display more continuity, and a separate form used to evaluate each
reach. The total score assigned to a stream reach must range between 0 and 100, with a score of 100 representing a stream of the
highest quality.
Total Score (from reverse): 59
Comments:
Evaluator's Signature Date 04/26/2017
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
2
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
4
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
6
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
5
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
3
U(no
discharge = 0; springs, seeps, wetlands, etc. = max points)
6
Presence of adjacent floodplain
0-4
0-4
0-2
3
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
5
p"
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
3
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
3
(extensive channelization = 0; natural meander = max points)
10
Sediment input
0-5
0-4
0-4
4
(extensive deposition= 0; little or no sediment = max points)
11
Size & diversity of channel bed substrate
NA*
0-4
0-5
NA
(fine, homogenous = 0; large, 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)
E*Presence
13
of major bank failures
0-5
0-5
0-5
4
a
04
(severe erosion = 0; no erosion, stable banks = max points)
M
14
Root depth and density on banks
0-3
0-4
0-5
3
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
4
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
0
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
0
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
rj
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
1
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = max points)
23
Evidence of wildlife use
0-6
0-5
0-5
1
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
59
* These characteristics are not assessed in coastal streams.

Notes on Characteristics Identified in Assessment Worksheet
1. Consider channel flow with respect to channel cross-sectional area (expected flow), drainage area, recent precipitation, potential
drought conditions, surrounding land use, possible water withdrawals, presence of impoundments upstream, vegetation growth in
channel bottom (as indicator of intermittent flow), etc.
2. Human -caused alterations may include relocation, channelization, excavation, riprap, gabions, culverts, levees, berms, spoil piles
adjacent to channel, etc.
3. The riparian zone is the area of vegetated land along each side of a stream or river that includes, but is not limited to, the
floodplain. Evaluation should consider width of riparian area with respect to floodplain width, vegetation density, maturity of
canopy and understory, species variety, presence of undesirable invasive species (exotics), breaks (utility corridors, roads, etc.),
presence of drainage tiles, logging activities, other disturbances which negatively affect function of the riparian zone.
4. Evidence of nutrient or chemical discharges includes pipes, ditches, and direct draining from commercial and industrial sites,
agricultural fields, pastures, golf courses, swimming pools, roads, parking lots, etc. Sewage, chlorine, or other foul odors,
discolored water, suds, excessive algal growth may also provide evidence of discharge.
5. Groundwater discharge may be indicated by persistent pools and saturated soils during dry weather conditions, presence of
adjacent wetlands, seeps, and springs feeding channel, reduced soils in channel bottom.
6. Presence of floodplains may be determined by topography and the slope of the land adjacent to the stream, terracing, the extent of
development within the floodplain, FEMA designation if known, etc.
7. Indicators of floodplain access include sediment deposits, wrack lines, drainage patterns in floodplain, local stream gauge data,
testimony of local residents, entrenchment ratio, etc. Note that indicators may relic and not a result of regular flooding.
8. Wetland areas should be evaluated according to their location, size, quality, and adjacency relative to the stream channel, and
may be indicated by beaver activity, impounded or regularly saturated areas near the stream, previous delineations, National
Wetland Inventory maps, etc. (Wetlands must meet criteria outlined in 1987 delineation manual and are subject to USACE approval.)
9. Channel sinuosity should be evaluated with respect to the channel size and drainage area, valley slope, topography, etc.
10. To evaluate sediment deposition within the channel consider water turbidity, depth of sediment deposits forming at point bars and
in pools, evidence of eroding banks or other sediment sources within watershed (construction sites, ineffective erosion controls). In
rare cases, typically downstream of culverts or dams, a sediment deficit may exist and should be considered in scoring.
11. When looking at channel substrate, factor in parent material (presence of larger particles in soil horizons adjacent to the stream), average
size of substrate (bedrock, clay/silt, sand, gravel, cobble, boulder, etc.), and diversity of particle size (riprap is excluded).
12. Indications of channel incision and deepening may include a v -shaped channel bottom, collapsing banks, evidence of recent
development and increased impervious surface area resulting in greater runoff in the watershed.
13. Evaluation should consider presence of major bank failures along the entire reach under evaluation, including uprooted trees on
banks, banks falling into channel, formation of islands in channel as they widen, exposed soil, active zones of erosion, etc.
14. Increased root depth and density result in greater bank stability. Consider the depth and density that roots penetrate the bank
relative to the amount of exposed soil on the bank and the normal water elevation.
15. Assessment of agriculture, livestock, and/or timber production impacts should address areas of stream bank destabilization,
evidence of livestock in or crossing stream, loss of riparian zone to pasture or agricultural fields, evidence of sediment or high
nutrient levels entering streams, drainage ditches entering streams, loss of riparian zone due to logging, etc.
16. Riffle -pool steps can be identified by a series of alternating pools and riffles. Abundance, frequency, and relative depth of riffles
and pools should be considered with respect to topography (steepness of terrain) and local geology (type of substrate).
Coastal plain streams should be evaluated for the presence of ripple -pool sequences. Ripples are bed forms found in sand bed
streams with little or no gravel that form under low shear stress conditions, whereas, dunes and antidunes form under moderate
and high shear stresses, respectively. Dunes are the most common bed forms found in sand bed streams.
17. Habitat complexity is an overall evaluation of the variety and extent of in -stream and riparian habitat. Types of habitat to look
for include rocks/cobble, sticks and leafpacks, snags and logs in the stream, root mats, undercut banks, overhanging vegetation,
pool and riffle complexes, wetland pockets adjacent to channel, etc.
18. Evaluation should consider the shading effect that riparian vegetation will provide to the stream during the growing season. Full
sun should be considered worst case, while good canopy coverage with some light penetration is best case.
19. Stream embeddedness refers to the extent that sediment that has filled in gaps and openings around the rocks and cobble in the
streambed. The overall size of the average particle in the streambed should be considered (smaller rocks will have smaller gaps).
20. Evaluation should be based on evidence of stream invertebrates gathered from multiple habitats. Scores should reflect
abundance, taxa richness, and sensitivity of stream invertebrate types. (see attached examples of common stream invertebrates on page
4).
21. Evaluation should include evidence of amphibians in stream channel. Tadpoles and frogs should receive minimum value, while
salamanders, newts, etc. may be assigned higher value.
22. Evaluation of fish should consider the frequency and, if possible, the variety of different fish taxa observed.
23. Evaluation of wildlife should include direct observation or evidence (tracks, shells, droppings, burrows or dens, hunting stands, evidence
of fishing, etc.) of any animals using the streambed or riparian zone, to include small and large mammals, rodents, birds, reptiles,
insects, etc.

Common Stream Invertebrates
Sensitive Taxa — Pollution sensitive organisms that may be found in good quality water.
Caddisfly
Mayfly
Stonefly
Dobsonfly
Riffle Beetle
Water Penny
Gilled Snail
Somewhat Tolerant Taxa — Somewhat pollution tolerant organisms that may be found in good or
Beetle Larva
Clam
Crayfish Damselfly Nymph
Sowbug
Scud
Cranefly
N
Dragon Fly Nymph
Tolerant Taxa — Pollution tolerant organisms that may be found in anv quality water.
Blackfly Larva Leech Midge Fly Larva
,r
,r
R 1 .
Aquatic Worm Pouch & Pond Snail
4

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: Dominion North Carolina Power 2. Evaluator's name: LC, JC
3. Date of evaluation: 4/26/17 4. Time of evaluation: 10:56pm
5. Name of stream: shac036 - UNT to Beech Swamp 6. River basin: Tar -Pamlico
7. Approximate drainage area: 4 acres 8. Stream order:
9. Length of reach evaluated: 295 ft 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.204504
12. Subdivision name (if any): N/A
Longitude (ex. -77.556611): -77.605966
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
14. Proposed channel work (if any): N/A
15. Recent weather conditions: sunny
16. Site conditions at time of visit: flooded from heavy rain
17. Identify any special waterway classifications known:
Trout Waters . Outstanding Resource Waters
Section 10 Tidal Waters _Essential Fisheries Habitat
Nutrient Sensitive Waters Water Supply Watershed - .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' �f 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: 110 % Residential % Commercial % Industrial 60 % Agricultural
30 % Forested % Cleared / Logged % Other ( )
22. Bankfull width: 3ft 23. Bank height (from bed to top of bank): 1ft
24. Channel slope down center of stream: _Flat (0 to 2%) X Gentle (2 to 4%) _Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: _ Straight '0' Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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): 62
Comments:
Evaluator's Signature Date 04/26/2017
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
3
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
4
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
5
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
5
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
3
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
U
6
Presence of adjacent floodplain
0-4
0-4
0-2
3
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
4
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
4
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
3
(extensive channelization = 0; natural meander = max points)
10
Sediment input
0-5
0-4
0-4
4
(extensive deposition= 0; little or no sediment = max points)
11
Size & diversity of channel bed substrate
NA*
0-4
0-5
NA
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0-5
0-4
0-5
4
y+
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0-5
0-5
0-5
4
a
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0-3
0-4
0-5
2
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
4
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
1
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
2
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
3
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
2
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = 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 first page)
62
* These characteristics are not assessed in coastal streams.

Notes on Characteristics Identified in Assessment Worksheet
1. Consider channel flow with respect to channel cross-sectional area (expected flow), drainage area, recent precipitation, potential
drought conditions, surrounding land use, possible water withdrawals, presence of impoundments upstream, vegetation growth in
channel bottom (as indicator of intermittent flow), etc.
2. Human -caused alterations may include relocation, channelization, excavation, riprap, gabions, culverts, levees, berms, spoil piles
adjacent to channel, etc.
3. The riparian zone is the area of vegetated land along each side of a stream or river that includes, but is not limited to, the
floodplain. Evaluation should consider width of riparian area with respect to floodplain width, vegetation density, maturity of
canopy and understory, species variety, presence of undesirable invasive species (exotics), breaks (utility corridors, roads, etc.),
presence of drainage tiles, logging activities, other disturbances which negatively affect function of the riparian zone.
4. Evidence of nutrient or chemical discharges includes pipes, ditches, and direct draining from commercial and industrial sites,
agricultural fields, pastures, golf courses, swimming pools, roads, parking lots, etc. Sewage, chlorine, or other foul odors,
discolored water, suds, excessive algal growth may also provide evidence of discharge.
5. Groundwater discharge may be indicated by persistent pools and saturated soils during dry weather conditions, presence of
adjacent wetlands, seeps, and springs feeding channel, reduced soils in channel bottom.
6. Presence of floodplains may be determined by topography and the slope of the land adjacent to the stream, terracing, the extent of
development within the floodplain, FEMA designation if known, etc.
7. Indicators of floodplain access include sediment deposits, wrack lines, drainage patterns in floodplain, local stream gauge data,
testimony of local residents, entrenchment ratio, etc. Note that indicators may relic and not a result of regular flooding.
8. Wetland areas should be evaluated according to their location, size, quality, and adjacency relative to the stream channel, and
may be indicated by beaver activity, impounded or regularly saturated areas near the stream, previous delineations, National
Wetland Inventory maps, etc. (Wetlands must meet criteria outlined in 1987 delineation manual and are subject to USACE approval.)
9. Channel sinuosity should be evaluated with respect to the channel size and drainage area, valley slope, topography, etc.
10. To evaluate sediment deposition within the channel consider water turbidity, depth of sediment deposits forming at point bars and
in pools, evidence of eroding banks or other sediment sources within watershed (construction sites, ineffective erosion controls). In
rare cases, typically downstream of culverts or dams, a sediment deficit may exist and should be considered in scoring.
11. When looking at channel substrate, factor in parent material (presence of larger particles in soil horizons adjacent to the stream), average
size of substrate (bedrock, clay/silt, sand, gravel, cobble, boulder, etc.), and diversity of particle size (riprap is excluded).
12. Indications of channel incision and deepening may include a v -shaped channel bottom, collapsing banks, evidence of recent
development and increased impervious surface area resulting in greater runoff in the watershed.
13. Evaluation should consider presence of major bank failures along the entire reach under evaluation, including uprooted trees on
banks, banks falling into channel, formation of islands in channel as they widen, exposed soil, active zones of erosion, etc.
14. Increased root depth and density result in greater bank stability. Consider the depth and density that roots penetrate the bank
relative to the amount of exposed soil on the bank and the normal water elevation.
15. Assessment of agriculture, livestock, and/or timber production impacts should address areas of stream bank destabilization,
evidence of livestock in or crossing stream, loss of riparian zone to pasture or agricultural fields, evidence of sediment or high
nutrient levels entering streams, drainage ditches entering streams, loss of riparian zone due to logging, etc.
16. Riffle -pool steps can be identified by a series of alternating pools and riffles. Abundance, frequency, and relative depth of riffles
and pools should be considered with respect to topography (steepness of terrain) and local geology (type of substrate).
Coastal plain streams should be evaluated for the presence of ripple -pool sequences. Ripples are bed forms found in sand bed
streams with little or no gravel that form under low shear stress conditions, whereas, dunes and antidunes form under moderate
and high shear stresses, respectively. Dunes are the most common bed forms found in sand bed streams.
17. Habitat complexity is an overall evaluation of the variety and extent of in -stream and riparian habitat. Types of habitat to look
for include rocks/cobble, sticks and leafpacks, snags and logs in the stream, root mats, undercut banks, overhanging vegetation,
pool and riffle complexes, wetland pockets adjacent to channel, etc.
18. Evaluation should consider the shading effect that riparian vegetation will provide to the stream during the growing season. Full
sun should be considered worst case, while good canopy coverage with some light penetration is best case.
19. Stream embeddedness refers to the extent that sediment that has filled in gaps and openings around the rocks and cobble in the
streambed. The overall size of the average particle in the streambed should be considered (smaller rocks will have smaller gaps).
20. Evaluation should be based on evidence of stream invertebrates gathered from multiple habitats. Scores should reflect
abundance, taxa richness, and sensitivity of stream invertebrate types. (see attached examples of common stream invertebrates on page
4).
21. Evaluation should include evidence of amphibians in stream channel. Tadpoles and frogs should receive minimum value, while
salamanders, newts, etc. may be assigned higher value.
22. Evaluation of fish should consider the frequency and, if possible, the variety of different fish taxa observed.
23. Evaluation of wildlife should include direct observation or evidence (tracks, shells, droppings, burrows or dens, hunting stands, evidence
of fishing, etc.) of any animals using the streambed or riparian zone, to include small and large mammals, rodents, birds, reptiles,
insects, etc.

Common Stream Invertebrates
Sensitive Taxa — Pollution sensitive organisms that may be found in good quality water.
Caddisfly
Mayfly
Stonefly
Dobsonfly
Riffle Beetle
Water Penny
Gilled Snail
Somewhat Tolerant Taxa — Somewhat pollution tolerant organisms that may be found in good or
Beetle Larva
Clam
Crayfish Damselfly Nymph
Sowbug
Scud
Cranefly
N
Dragon Fly Nymph
Tolerant Taxa — Pollution tolerant organisms that may be found in anv quality water.
Blackfly Larva Leech Midge Fly Larva
,r
,r
R 1 .
Aquatic Worm Pouch & Pond Snail
4

USACE AID#
DWQ#
Site # (indicate on attached map)
M -A4P
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name: Dominion North Carolina Power 2. Evaluator's name: Jonathan Connelly, Laura Clark
3. Date of evaluation: 3/8/17 4. Time of evaluation: 9:08 AM
5. Name of stream: UNT to Deep Creek 6. River basin: Tar -Pamlico
7. Approximate drainage area: 5 acres 8. Stream order:
9. Length of reach evaluated: 150ft 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.160016
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.509160
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
14. Proposed channel work (if any): N/A
15. Recent weather conditions: Cloudy
16. Site conditions at time of visit: Winter, dormant species
17. Identify any special waterway classifications known:
Trout Waters . Outstanding Resource Waters
Section 10 Tidal Waters _Essential Fisheries Habitat
Nutrient Sensitive Waters Water Supply Watershed - .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' / If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' �f 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: % Residential % Commercial % Industrial % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 6ft 23. Bank height (from bed to top of bank): 4ft
24. Channel slope down center of stream: _Flat (0 to 2%) _Gentle (2 to 4%) -X-Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: _ Straight '0' Occasional bends Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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): 28
Comments:
Evaluator's Signature LC Date 03/8/17
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
0
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
2
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
1
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
4
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
1
(no discharge = 0; springs, seeps, wetlands, etc. = max points)
U
6
Presence of adjacent floodplain
0-4
0-4
0-2
2
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
0
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
0
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
0
(extensive channelization = 0; natural meander = max points)
10
Sediment input
0-5
0-4
0-4
4
(extensive deposition= 0; little or no sediment = max points)
11
Size & diversity of channel bed substrate
NA*
0-4
0-5
NA
(fine, homogenous = 0; large, diverse sizes = max points)
12
Evidence of channel incision or widening
0-5
0-4
0-5
2
y+
(deeply incised = 0; stable bed & banks = max points)
13
Presence of major bank failures
0-5
0-5
0-5
2
a
(severe erosion = 0; no erosion, stable banks = max points)
14
Root depth and density on banks
0-3
0-4
0-5
0
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
5
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
0
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
0
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
4
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
1
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = max points)
23
Evidence of wildlife use
0-6
0-5
0-5
0
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
28
* These characteristics are not assessed in coastal streams.

USACE AID#
DWQ#
Site # (indicate on attached map)
STREAM QUALITY ASSESSMENT WORKSHEET
Provide thefollowing information for the stream reach under assessment:
1. Applicant's name: Dominion North Carolina Power 2. Evaluator's name: Jonathan Connelly, Laura Clark
3. Date of evaluation: 2/16/17 4. Time of evaluation: 1:30 PM
5. Name of stream: LINT to Deep Creek 6. River basin: Tar -Pamlico
7. Approximate drainage area: 75 acres 8. Stream order: 3
9. Length of reach evaluated: 215ft 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.126868
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.443208
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
Located perpendicular to the survey corridor.
14. Proposed channel work (if any): N/A
15. Recent weather conditions: Yesterday morning/afternoon rain
16. Site conditions at time of visit: Undisturbed
17. Identify any special waterway classifications known: Section 10 Tidal Waters _Essential Fisheries Habitat
Trout Waters . Outstanding Resource Waters Nutrient Sensitive Waters Water Supply Watershed _ .(I-IV)
18. Is there a pond or lake located upstream of the evaluation point? ' / If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? ' / 20. Does channel appear on USDA Soil Survey? NES NO
21. Estimated watershed land use: % Residential % Commercial % Industrial 30 % Agricultural
70 % Forested % Cleared / Logged % Other ( )
22. Bankfull width: 6ft 23. Bank height (from bed to top of bank): 2ft
24. Channel slope down center of stream: _Flat (0 to 2%) _Gentle (2 to 4%) _X_Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: _ Straight Occasional bends / Frequent meander Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the worksheet. Scores should reflect an overall assessment of the stream reach under evaluation. If a
characteristic cannot be evaluated due to site or weather conditions, enter 0 in the scoring box and provide an explanation in the
comment section. Where there are obvious changes in the character of a stream under review (e.g., 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): 63
stream.
Comments: Wide floodplain extends from stream edges, much wrack along
Evaluator's Signature Jonathan Connelly Date 2/16/17
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 call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET
* These characteristics are not assessed in coastal streams.
#
CHARACTERISTICS
ECOREGION POINT
RANGE
SCORE
Coastal
Piedmont
Mountain
1
Presence of flow / persistent pools in stream
0-5
0 — 4
0-5
4
(no flow or saturation = 0; strong flow = max points)
2
Evidence of past human alteration
0-6
0 5
0-5
5
(extensive alteration = 0; no alteration = max points)
3
Riparian zone
0-6
0-4
0-5
6
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
5
(extensive discharges = 0; no discharges = max points)
5
Groundwater discharge
0-3
0-4
0-4
2
U(no
discharge = 0; springs, seeps, wetlands, etc. = max points)
6
Presence of adjacent floodplain
0-4
0-4
0-2
4
(no floodplain = 0; extensive floodplain = max points)
x
7
Entrenchment / floodplain access
0-5
0-4
0-2
5
p"
(deeply entrenched = 0; frequent flooding = max points)
8
Presence of adjacent wetlands
0-6
0-4
0-2
0
(no wetlands = 0; large adjacent wetlands = max points)
9
Channel sinuosity
0-5
0-4
0-3
5
(extensive channelization = 0; natural meander = max points)
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
NA
(fine, homogenous = 0; large, 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)
E*Presence
13
of major bank failures
0-5
0-5
0-5
3
a
04
(severe erosion = 0; no erosion, stable banks = max points)
M
14
Root depth and density on banks
0-3
0-4
0-5
(no visible roots = 0; dense roots throughout =max points)
15
Impact by agriculture, livestock, or timber production
0-5
0-4
0-5
5
(substantial impact =0; no evidence = max points)
16
Presence of riffle-pool/ripple-pool complexes
0-3
0-5
0-6
3
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
2
�
(little or no habitat = 0; frequent, varied habitats = max points)
18
Canopy coverage over streambed
0-5
0-5
0-5
5
(no shading vegetation = 0; continuous canopy = max points)
19
Substrate embeddedness
NA*
0-4
0-4
NA
(deeply embedded = 0; loose structure = max)
20
Presence of stream invertebrates (see page 4)
0-4
0-5
0-5
0
(no evidence = 0; common, numerous types = max points)
21
Presence of amphibians
0-4
0-4
0-4
0
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
0
(no evidence = 0; common, numerous types = 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 first page)
63
* These characteristics are not assessed in coastal streams.