20171153 Ver 1_401 Application_20170911

20171153
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the Corps:X❑
Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
❑X Yes ❑ No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ❑X No
For the record only for Corps Permit:
❑ Yes ❑X No
1f. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
❑ Yes ❑X No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes Q No
1 In. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2. Project Information
2a. Name of project:
DeWeese Home Construction
2b. County:
Wake
2c. Nearest municipality / town:
Apex
2d. Subdivision name:
Property of T.S. Wheeler
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
1 201
3a. Name(s) on Recorded Deed:
Sp
Keith DeWeese, Tara DeWeeseft;F:
3b. Deed Book and Page No.
015973 p02487 RES U
7
3c. Responsible Party (for LLC if
applicable):
401 BU
Keith DeWeese
3d. Street address:
425 Holly Thorn Trace
3e. City, state, zip:
Holly Springs, NC 27540
3f. Telephone no.:
919-522-1977
3g. Fax no.:
3h. Email address:
[e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2of10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
0770126378
1 b. Site coordinates (in decimal degrees):
I Latitude: 35.679702 Longitude: -78.758581
1 c. Property size:
5.07 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Camp Branch
2b. Water Quality Classification of nearest receiving water:
C;NSW
2c. River basin:
Neuse
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Wooded lot on a cul-de-sac. All other lots on cul-de-sac already developed with houses.
3b. List the total estimated acreage of all existing wetlands on the property: 0.28
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 600
3d. Explain the purpose of the proposed project:
Create additional yard space by clearing underbrush and smoothing out the surface of the ground to fill in the various holes and make it
drain properly. This will be safer for children than it would be without modification, will allow me to better control an invasive weed that
currently rovers thog area and it well allow me tn make wgp of more of my prope* wholp still leaving roughly half of it untourhpd_
3e. Describe the overall project in detail, including the type of equipment to be used:
Stream channels will be undisturbed. Larger wetland area to the east will be undisturbed. The smaller (.08 acre) wetland and the area
around it will be cleared of smaller trees and underbrush using heavy equipment. Large trees will remain. The ground will be graded and
smoothed as much as possible without disturbing the remainina trees and rass will be planted.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases)in the past?
❑X Yes ❑ No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
x❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): James Lastinger
Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
March 20, 2015. Re -surveyed on July 6, 2017
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑Yes ❑X No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑X Wetlands ❑ Streams —tributaries ❑ Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
Wetland impact
number
Permanent (P) or
Temporary T
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 P
Land Clearing
Unknown
Yes
Corps
0.08
W2 -
Choose one
Choose one
Yes/No
-
W3 -
Choose one
Choose one
Yes/No
-
W4 -
Choose one
Choose one
Yes/No
-
W5 -
Choose one
Choose one
Yes/No
-
W6 -
Choose one
Choose one
Yes/No
-
2g. Total Wetland Impacts:
2h. Comments:
Larger wetland to the west will remain untouched
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 -
Choose one
-
-
S2 -
Choose one
-
-
S3 -
Choose one
-
-
S4 -
Choose one
-
-
S5 -
Choose one
-
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
3i. Comments:
Stream channel will not be affected
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01 -
Choose one
Choose
02 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d. 5e.
Stream Impacts (feet) Upland
(acres)
Flooded
Filled Excavated
Flooded Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number —
Permanent (P) or
Temporary
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
B1 -
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Stream channels are left untouched. Larger wetland is left untouched.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Large trees will be left in place. Silt fences will be used where needed
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ❑X No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
El Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
Choose one
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
Yes Q No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules?
❑ Yes ❑ No
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
3
2b. Does this project require a Stormwater Management Plan?
❑ Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which localgovernment's jurisdiction is thisproject?
Wake County
3b. Which of the following locally -implemented stormwater management programs
apply (check all that apply):
❑ Phase II
❑ NSW
El USMP❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
4. DWQ Stormwater Program Review
4a. Which of the following state -implemented stormwater management programs apply
(check all that apply):
❑Coastal counties
❑HQW
ORW
HSession Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/stateAocal) funds or the
❑ Yes ❑X No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered 'yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes ❑ No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑Yes Q No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
El Yes ❑X No
2c. If you answered 'yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑Yes ❑X No
additional development, which could impact nearby downstream water quality?
3b. If you answered 'yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
tank
Standard septic system with pump
Page 9of10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ❑X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
El Yes No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
S. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ❑X No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes Q No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Raleigh IMAPS
A- Inlee5-P
0 -b
JV21,--
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Page 10 of 10

NGo
\
.. I
G
\ I
\
\ \ aA YTOV A WARD I
\ WLLIAM aANCE\ DB 110261282 I
\ \ OB 159JI12608 SM 1985/1174
\ \ BM /985/1274 \ I
JOHN C. KLM
DB IJ12912595
BM 1985/1174
I'M'Wir� �vaAn9'r10Td, —
DONALD a RAMEY
DB 11132/809
BM I98511274
Irl mr¢i 01 Ng} 62
"NCO
LARRY L COATS
0889461954 \ I \
Boundary Survey for:
Keith A. DeWeese
and
Tara DeWeese
Site Information
Property Address: 3421 Hardwood Drive- Apex, NC 27539
Subdivision: Property of T.S. Wheeler
Lot: 6
Swift Creek Township
Wake County, North Carolina
Survey Date: 3-12-15 Wetlands Added: 7-13-17
House
Dri—ay
Driveway: 3k ft^2
House: 3k ft^2
Impervious Surface Calculation:
6k/221k=3%
Cleared Area:
81,082 sq. ft aA nozA/ze
1.86 acres BM 1985/1274
C7NOUNE CXM
98490 (TOTA(f
TLE BROCKSHIRE \
MANOR INLESTMENT, LLC
DB 15147/7769 \
BM 20061157J
/ Wetland 1
Leave tall trees
Clear underbrush
Till, grade, plant grass
30,000 sq. ft
0.7 acres
(MARKED 8r -4V< LOT 6
3,674 TL
oc es I
OTB
MICHAEL STEII'ART
DB 15651/2742
BM 2006/1573
of buffer
Legend
- &Whq bm Ph
Q I
Ner Iran Ph
O
E.*thq No/
NO SO
iMARY POM
Co Wted Pouf
A
Ca to M—t
11
avbd Mmlmeet
Riot of wy R/W
Cot". C
C/
�rsD's7F
1$71
Wetland 2
570 sq.
020 acres
\ XSEPN MUDCER \
\ OB 13990/1622 \
\
BY 2006/1573 \
GRAPHIC SCALE
eo 0 ]0 60 130 2.
( IN FEST )
1 inch = 60 ft

ka,
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: p 2. Evaluator's name:
3. Date of evaluation: / 4. Time of evaluation: f
5. Name of stream: 6. River basin: 11
/
7. Approximate drainage area: 3 0 a K a 8. Stream order: / A xi
9. Length of reach evaluated: 600 10. County:
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): � (0a 1� : Longitude (ex. —77.556611)�� 3 '
Method location determined (circle): NP 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 conditions:
I
16. Site conditions at time of visit:
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? YES1V0 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 -`NO
21. Estimated watershed land use: % Residential a % Commercial % Industrial 1�o 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): C
Evaluator's Signature=%%/F/�/ F� �i Date
This channel evaluation�foj'in is intended to befused only as a guide to assist landowners and nvi • nmental 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
* These characteristics are not assessed in coastal streams.
2
d,
0
10
I
GL

USACE AID# DWQ # Site # (indicate on attached map)
C] STREAM QUALITY ASSESSMENT WORKSHEET ..1• .
Provide the following information for the stream reach under assessment:
1. Applicant's name: - 1-964ddb 0, "o- v 2. Evaluator's name:
3. Date of evaluation: 4. Time of evaluation:
5. Name of stream: s` 6. River basin:
7. Approximate drainage area: t',`' �'J 8. Stream order:
9. Length of reach evaluated: /00/ 10. County:
A/.A,
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): �� , Longitude (ex. -77.556611):
-77,411
Method location determined (circle):P , 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):
/J,O.-,4 ,* .114) 1 , /:,.. .� 44 r/- a V / /,� (/-a//,&W ,/
14. Proposed channel work (if any):,
15. Recent weather conditions:
16. Site conditions at time of visit:
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 -IU)
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 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: 3> % Residential cZ, % Commercial % Industrial % Agricultural
% Forested % Cleared / Logged _% Other
22. Bankfull width: ,5 23. Bank height (from bed to top of bank):
24. Channel slope down center of stream: ✓�F1at (0 to 2%) _Gentle (2 to 4%) Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: V"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): Comments: Gluey �%� 4'/
' g ' a" ,i Date; :` s�'
Evaluator's Signature: �
This channel evaluation form�.fs intended &' e usedonly as a guide to assist landowners and etivironmental 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.

d
STREAM QUALITY ASSESSMENT WORKSHEET ,
* These characteristics are not assessed in coastal streams.
2
,21
1�
I
0

Aa,q
USACE AID# DWQ # Site # (indicate on attached map)
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following 'nformation for the stream reach under assessment:
rte'
1. Applicant's name: :�� i 2. Evaluator's name:
N
3. Date of evaluation: �` 4. Time of evaluation:
S. Name of stream: 6. River basin:
7. Approximate drainage area: 8. Stream order:
9. Length of reach evaluated: ,�� 10. County:
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): 31. (, J� Longitude (ex. -77.556611):
Method location determined (circle): GP 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):/
4ar14 g � .9 //G ,"
i%x -if ; li -4e ,, / v
t"S, I/ - ins
14. Proposed channel work (if any):,
15. Recent weather conditions:
"f
16. Site conditions at time of visit: 4,:'InA /
17. Identify any special waterway classifications known: _Section 10 _Tidal Waters Essential Fisheries Habitat
Trout Waters _Outstanding Resource _Waters _Nutrient Sensitive Waters --__Watery 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 lam' 20. Does channel appear on USDA Soil Survey? YES s 0
21. Estimated watershed land use: % Residential aZ % Commercial _% Industrial % Agricultural
% Forested % Cleared / Logged _% Other
22. Bankfull width: 7`123. 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): OU, Comments
Date
Evaluator's Signature
This channel evaluation f rn fs intended td be used ably 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 J�aj W/
*
* These characteristics are not assessed in coastal streams.
2
--0--
10 -0--
0
M-

C)ka01 ---1
USACE AID# DWQ # Site # (indicate on attached map) I
M
STREAM QUALITY ASSESSMENT WORKSHEET -
Provide the following information for the stream reach under assessment:
1. Applicant's name / 2. Evaluator's name:
3. Date of evaluation: / //� / �' 4. Time of evaluation:
5. Name of stream: 6. River basin: �'z---/
e
7. Approximate drainage area: �(� 8. Stream order:OJ%
9. Length of reach evaluated: 10. County:�ii`"
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): Longitude (ex. —77.556611): ®.
Method location determined (circle): GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evaluatio note nearby roads and landmarks and attach map identifying stream(s) location):
oil A106-7-0
14. Proposed chanhel work (if any):,
15. Recent weather conditions:
d i
16. Site conditions at time of visit:
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 (9 If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? YES NO 20. Does channel appear on USDA Soil SurveyF%I.Agiricultural NO
21. Estimated watershed land use: % Residential % Commercial % Industrial
(20% Forested % Cleared / Logged % Other ( )
22. Bankfull width: -3/ 23. Bank height (from bed to top of bank): 3 /
24. Channel slope down center of stream: Flat (0 to 2%) ''Gentle (2 to 4%) _Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: Straight Occasional bends _Frequent meander _Very sinuous Braided channel
Instructions for completion of worksheet (located on page 2): Begin by determining the most appropriate ecoregion based on
location, terrain, vegetation, stream classification, etc. Every characteristic must be scored using the same ecoregion. Assign points
to each characteristic within the range shown for the ecoregion. Page 3 provides a brief description of how to review the
characteristics identified in the 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 SignatureDate
f
This channel evaluationrm is intended io be used only as a guide to assist landowners and nvir, nmental 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 jIlia q
* These characteristics are not assessed in coastal streams.
2
AA
FJ

C)hII
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: i5 2. Evaluator's name:
3. Date of evaluation: �� 4. Time of evaluation:
i
S. Name of stream: 6. River basin: W1
7. Approximate drainage area: 8. Stream order:
9. Length of reach evaluated: 10. County:
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): 3� . /3®w Lonaitude (ex. —77.556611): 11771 e 1/
Method location determined (circle): 6S 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):
JWIAZWi f
14. Proposed channel work (if any): /V q-
15. Recent weather conditions: 41a 641 �J &&-Z0l � X /1/917,(-1
16. Site conditions at time of visit: ®0��1�1
17. Identify any special waterway classifications known: _Section 10 _Tidal Waters Essential Fisheries Habitat
_Trout Waters -_Outstanding Resource Waters Nutrient Sen ' e 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?S NO 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: % Residential 3 % Commercial % Industrial '16-.10 y% Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: ' 1 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): ! Comments:
Evaluator's Signature �'�i� �' , -�/ Date 1
This channel evaluationfo`r�A is intended to be use only as a guide to assist landowners and nvirgirmental professionals in
gathering the data required by the United Stat s 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 'I'lj aq 6/,/
* These characteristics are not assessed in coastal streams.
2
101
0

USACE AID#
DWQ #.
J k1(q
Site # (indicate on attached map)
,o,; STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name: 0 �d `A Z 2. Evaluator's name: �` /I
3. Date of evaluation:3 3
n, 17 4. Time of evaluation:
S. Name of stream: W4 6. River basin: /c /
7. Approximate drainage area: -\ r le-,( 8. Stream order:
9. Length of reach evaluated: 10. County:
/��
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): (e131v6- Longitude (ex. —77.556611): —' s i f
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 conditions: 1le 0-1 AJ/ /, -1
16. Site conditions at time of visit:
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 X10 If yes, estimate the water surface area:
19. Does channel appear on USGS quad map? YES NO zz20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: % Residential J % Commercial % Industrial '?6-0/o Agricultural
/ % Forested % Cleared / Logged % Other
22. Bankfull
24. Channel slope down center of stream: /'Flat (0 to 2%)
25. Channel sinuosity: Straight _Occasional bends
23. Bank height (from bed to top of bank):
_Gentle (2 to 4%) _Moderate (4 to 10%) %Steep (>10%)
_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.
Evaluator's Signature Date
This channel evaluation form is intended(to be used�only as a guide to assist landowners and/envie,onmental professionals in
gathering the data required by the United States Army Corps of Engineers to make a preliminary assessment of stream
quality. The total score resulting from the completion of this form is subject to USACE approval and does not imply a
particular mitigation ratio or requirement. Form subject to change — version 06/03. To Comment, please call 919-876-8441 x 26.

STREAM QUALITY ASSESSMENT WORKSHEET j � M q W�7
* These characteristics are not assessed in coastal streams.
2
r
A/A
0
0
0
10

ao�
USACE AID# DWQ # Site # (indicate on attached map)
C STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
1. Applicant's name: " 2. Evaluator's name: f
3. Date of evaluation: 4. Time of evaluation:
5. Name of stream: 6. River basin '" `$
7. Approximate drainage area: 8. Stream order: �.
9. Length of reach evaluated: 10. County:
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): U�7 Longitude (ex. —77.556611): / 7.
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 6hannel work (if any):
15. Recent weather conditions: �0 !�� �n �%�iir`` /. � zldXfY
16. Site conditions at time of visit:
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? 0 NO 20. Does channel appear on USDA Soil Survey? YES <0
21. Estimated watershed land use: % Residential % Commercial _% Industrial Ir.". Agricultural
% Forested % Cleared / Logged -5"% Other ( S' 0,04g.", �� )
22. Bankfull width:_ 23. Bank height (from bed to top of bank): Z /
24. Channel slope down center of stream: Flat (0 to 2%) _Gentle (2 to 4%) _Moderate (4 to 10%) _Steep (>10%)
25. Channel sinuosity: V"'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): / Comments:
f
Evaluator's Signature_ ,� � .-� `��,�' � ;' ,��• Date f-°
fo
This channel evaluation r;u is inte d be used4,nly as a guide to assist landowners and envinmentai 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 d d� ��1 0� (
* These characteristics are not assessed in coastal streams.
111
19
0
0
�O
z

I
USACE AID# DWQ # Site # (indicate on attached map)
STREAM QUALITY ASSESSMENT WORKSHEET
Provide the following information for the stream reach under assessment:
I. Applicant's name:A01414""-p,4 B � 2. Evaluator's name: Ala _
3. Date of evaluation: m _ 4. Time of evaluation:
5. Name of stream:— 14M � 6. River basin: ! P -- ,
7. Approximate drainage area: 8. Stream order: ,._ ted/ .
9. Length of reach evaluated:9 10. County: B r
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): r !Q 3 Longitude (ex. —77.556611): /
12
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):
-00-
14. Proposed channel work (if any): /Y
15. Recent weather conditions: /1 /l l /I //✓ B� / I" ./
16. Site conditions at time of visit: Al e)l,' I
17. Identify any special waterway classifications known: _Section 10 Tidal Waters Essential Fisheries Habitat
Trout Waters __Outstanding Resource. Waters _ Nutrient Sensitive WatersWater Supply - -- (I-IV) - -
18. Is there a pond or lake located upstream of the evaluation point? YESO 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 NO
21. Estimated watershed land use:
22. Bankfull
% Residential
lf�% Forested
% Commercial _% Industrial % Agricultural
_% Cleared /Logged % Other
23. Bank height (from bed to top of bank): Q /f
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): Comments:
Evaluator's Signature %�9' ,, �' Date
This channel evaluation fo m is intended to be u4d only as a guide to assist landowners an envi onmental professionals in
gathering the data requi�ed by the United Stdies 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 AAA# �
* These characteristics are not assessed in coastal streams.
2
0
0
0
0
0
0

d 10 A
USACE AID# DWQ # Site # (indicate on attached map)
M STREAM QUALITY ASSESSMENT WORKSHEET r `
Provide the following information for the stream reach under assessment:
1. Applicant's name: / PIS > � 2° Evaluator's name:
-------- - - Z - - -- - -- - - ----- - -
3. Date of evaluation: ,1 4. Time of evaluation: zl
5. Name of stream: 6. River basin:
7. Approximate drainage area: 2 8. Stream order:
d/ I
9. Length of reach evaluated:� ®� 10. County:
11. Site coordinates (if known): prefer
prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): ��i � � Longitude (ex. —77.556611): 77, A2 AY'
Method location determined (circle):GPS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
13. Location of reach under evalua ion (note nearby roads and landmarks and attach map identifying stream(s) location):
14. Proposed channel work (if
15. Recent weather conditions
16. Site conditions at time of visit: 601"M A /
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(S)
ES O 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: % Residential % Commercial % Industrial A 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 fi-om 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. 0
Total Score (from reverse): I Comments:
Evaluator's Signatures a, r Dates
This channel evaluation fo °m is intended to be,/sed only as a guide to assist landowners and,Avironmental 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 JA0,1-0-to,
I
0
0
* 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: f `✓ -✓o'er✓ 4 2. Evaluator's name:
3. Date of evaluation: 4. Time of evaluation: a s�
5. Name of stream: 4/ 6. River basin:
7. Approximate drainage area:8. Stream order:
9. Length of reach evaluated: 2120 10. County:
11. Site coordinates (if known): prefer in decimal degrees. 12. Subdivision name (if any):
Latitude (ex. 34.872312): 2� i, jj o Longitude (ex. —77.556611): 7,
Method location determined (circle):PS Topo Sheet Ortho (Aerial) Photo/GIS Other GIS Other
11
13. Location of reach under evaluation (note nearby roads and landmarks and attach map identifying stream(s) location):
r
nil l>, /'/,9 / I --P117 - o - (I'l 7d - YAC o-/ id ' 27d
14. Proposed channel work (if any):
15. Recent weather conditions:
16. Site conditions at time of vi
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.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 NO
21. Estimated watershed land use: c� % Residential _% Commercial % Industrial ¢% Agricultural
% Forested
22. Bankfull width: /
_% Cleared / Logged % Other (
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: VntStraight _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 Signature rsow ' Dated 15 YAII
This channel evaluati n fVrm is intended to be us6d only as a guide to assist landowners and nvirov ental 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
n persistem poois in stream
rese ce of now
5 0 0 5
0—
'(6'flow of saWrdtion 0; strdhg flow 77 max
points)
. .. ...... /'
.... . .. Evidence of past human alteration
2 0-6 0-5 0-5
(F-.vtP.nQiuP. n1fP.rntinn —'0- nn'n1tf-.rPtinn —max nnink)
* These characteristics are not assessed in coastal streams.
2

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: 05/08/17 4. Time of evaluation: 11:57am
5. Name of stream: dhaw001 6. River basin: Tar -Pamlico
7. Approximate drainage area: 18 acres 8. Stream order: 3
9. Length of reach evaluated: -225 feet 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.110439
12. Subdivision name (if any): N/A
Longitude (ex. -77.556611): -77.426533
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):
Abuts whac005f
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 90 % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 7ft 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 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): 35
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
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
4
(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
1
(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
1
(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
0
(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
1
�
(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
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
1
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
35
* 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: 5/10/17 4. Time of evaluation: 12:30pm
5. Name of stream: dhaw002 6. River basin: Tar/Pamlico
7. Approximate drainage area: 2 acres 8. Stream order: 1
9. Length of reach evaluated: 96 feet 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.2054253
12. Subdivision name (if any): N/A
Longitude (ex. -77.556611): -77.5983111
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 RT481
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? ' �f 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: 110 % Residential % Commercial % Industrial 90 % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: loft 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%) _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): 14
Comments: No Fringe Wetland Present
Evaluator's Signature Date 05/10/2017
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
(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
0
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
2
(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
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
0
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
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
1
�
(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
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
2
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
14
* 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: 5/10/17 4. Time of evaluation: 1:30pm
5. Name of stream: dhaw003 6. River basin: Tar/Pamlico
7. Approximate drainage area: 37 acres 8. Stream order: 3
9. Length of reach evaluated: 2,419.4 ft 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.204492
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.585973
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 Sorietown Rd - Runs south
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? ' �f 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: 40 % Residential % Commercial % Industrial 60 % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 7ft 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): 26
Comments:
Evaluator's Signature Date 05/10/2017
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
3
(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
0
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
2
(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
3
(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
0
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
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
2
�
(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
3
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
2
(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)
26
* 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: 5/11/17 4. Time of evaluation: 8:50pm
5. Name of stream: dhaw004 6. River basin: Tar Pamilco
7. Approximate drainage area: "22.8 acres 8. Stream order: 1
9. Length of reach evaluated: -133 feet 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.1635936
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.5108542
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-west of the intersection of Thirteen Bridges Road and Stallion Rd.
14. Proposed channel work (if any): N/A
15. Recent weather conditions: Cloudy/Rain
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:
19. Does channel appear on USGS quad map? ' J 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: 25 % Residential % Commercial % Industrial 65 % Agricultural
10 % Forested % Cleared / Logged % Other ( )
22. Bankfull width: 20ft 23. Bank height (from bed to top of bank): 1 Oft
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): 199
snails
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
(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
0
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
2
(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
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
0
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
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
2
�
(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
1
O
(no evidence = 0; common, numerous types = max points)
O
22
Presence of fish
0-4
0-4
0-4
2
(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)
19
* 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: 5/11/17 4. Time of evaluation: 9:05am
5. Name of stream: dhaw005 6. River basin: Tar Pam
7. Approximate drainage area: <10 feet 8. Stream order: 0
9. Length of reach evaluated: -89 feet 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.1645925
12. Subdivision name (if any):
Longitude (ex. -77.556611): --77.5113623
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 west of the intersection of Thirteen Bridges Rd and Stallion Dr.
14. Proposed channel work (if any): N/A
15. Recent weather conditions: sunny
16. Site conditions at time of visi
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: % Residential % Commercial % Industrial % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: loft 23. Bank height (from bed to top of bank): 7ft
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): 188
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
(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
0
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
2
(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
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
0
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
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
2
�
(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
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)
18
* 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: 5/11/17
4. Time of evaluation: 9:25am
5. Name of stream: dhaw006
6. River basin: Tar/Pamlico
7. Approximate drainage area: 9 acres
8. Stream order: 1
9. Length of reach evaluated: -72 feet
10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees.
12. Subdivision name (if any): N/A
Latitude (ex. 34.872312): 36.1605708
Longitude (ex. -77.556611): -77.5018171
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 Bynums Bridge Road and South of Thirteen Bridges 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:
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: --3 acres
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
40 % Forested % Cleared / Logged % Other ( )
22. Bankfull width: 4ft 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): 122
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
(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
0
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
2
(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
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
0
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
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
0
(no riffles/ripples or pools = 0; well-developed = max points)
17
Habitat complexity
0-6
0-6
0-6
1
�
(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
1
(no evidence = 0; abundant evidence = max points)
Total Points Possible
100
100
100
TOTAL SCORE (also enter on first page)
12
* 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: 5/11/17 4. Time of evaluation: 10:15am
5. Name of stream: dhaw007 6. River basin: Tar/Pamlico
7. Approximate drainage area: 9 acres 8. Stream order: 1
9. Length of reach evaluated: -398 feet 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.1471443
12. Subdivision name (if any):
Longitude (ex. -77.556611): -77.469819
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 Sand Pit Road
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:
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: 5ft 23. Bank height (from bed to top of bank): 5ft
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): 11
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
(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
0
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
2
(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
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
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
0
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
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
2
�
(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
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)
* 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: 5/11/17 4. Time of evaluation: 10:27am
5. Name of stream: dhaw008 6. River basin: Tar/Pamlico
7. Approximate drainage area: 115 acres 8. Stream order: 1
9. Length of reach evaluated: 95 feet 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.1409997
12. Subdivision name (if any): N/A
Longitude (ex. -77.556611): -77.4669307
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 Sand Pit Road and West of Hardy Hall Road
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: 20 % Residential % Commercial % Industrial 80 % Agricultural
% Forested % Cleared / Logged % Other ( )
22. Bankfull width: 4ft 23. Bank height (from bed to top of bank): 2ft
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): 10
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
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
0
(no buffer = 0; contiguous, wide buffer = max points)
4
Evidence of nutrient or chemical discharges
0-5
0 — 4
0-4
2
(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
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
0
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
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
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)
10
* 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: 5/11/17 4. Time of evaluation: 10:25am
5. Name of stream: dhaw009 6. River basin: Tar/Pamlico
7. Approximate drainage area: 54 acres 8. Stream order: 2
9. Length of reach evaluated: 90 feet 10. County: Halifax
11. Site coordinates (if known): prefer in decimal degrees
Latitude (ex. 34.872312): 36.1118542
12. Subdivision name (if any): N/A
Longitude (ex. -77.556611): -77.4166982
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 and North of Kehukee Church Rd
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:
19. Does channel appear on USGS quad map? ' J 20. Does channel appear on USDA Soil Survey? YES NO
21. Estimated watershed land use: 5 % Residential % Commercial % Industrial 90 % Agricultural
% Forested 5 % Cleared / Logged % Other ( )
22. Bankfull width: 6ft 23. Bank height (from bed to top of bank): 6ft
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): 24
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
0
(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
2
(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
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
0
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
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
2
�
(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
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)
24
* 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