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HomeMy WebLinkAbout20171527 Ver 1_PJD_Person_County_Transportation_Corridor_20171127Burdette, Jennifer a From: Anna Reusche <Anna.Reusche@timmons.com> Sent: Monday, November 27, 2017 9:43 AM To: Roscoe.L.Sullivan@usace.army.mil; Bailey, David E CIV USARMY CESAW (US) Cc: Burdette, Jennifer a; Stuart C. Gilbert Subject: [External] Person County (Email lof 2) - Transportation Corridor PJD Attachments: PJD_Person_County_Transportation_Corridor_COMPILED r.pdf CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an attachment to Good morning, Timmons Group is pleased to present the attached pre jurisdictional determination request for the transportation corridor associated with the proposed Person County Mega -Site. Six (6) properties along the corridor were identified as having potentially jurisdictional streams/wetlands. Notification of those property owners and permission to access their property is still pending. We anticipate having those approvals shortly. In addition to the PJD attached, the next email will include the draft individual permit application to be reviewed and discussed at an on-site pre -application meeting. We respectively request that we go ahead and identify a date for the confirmation meeting and pre -application meeting, if possible, at this time. Please don't hesitate to call me on my cell with any questions or concerns. Thank you, Anna Reusche, PWS Environmental Project Manager TIMMONS GROUP I www.timmons.com 5410 Trinity Rd, Suite 102 1 Raleigh, NC 27607 Office: 919.866.4500 1 Fax: 919.859.5663 1 Mobile: 919-816-7745 anna.reuschektimmons.com Your Vision Achieved Through Ours To send me files greater than 20MB click here. TIMMONS GROUP YOUR VISION ACHIEVED THROUGH OURS. Mr. Ross Sullivan U.S. Army Corps of Engineers Raleigh Regulatory Field Office 3331 Heritage Trade Drive Wake Forest, North Carolina 27587 5410 Trinity Road Suite 210 Raleigh, NC 27607 November 20, 2017 Re: Stream and Wetland Delineation Confirmation Person County Mega -Site Transportation Corridor Person County, North Carolina Dear Mr. Sullivan, P 919.866.4951 F 919.859.5663 www.timmons.com Timmons Group is seeking confirmation of a wetland and stream delineation to identify Waters of the U.S. located within the proposed transportation corridor associated with the overall development of the Person County Mega -Site (see Figure 1: Vicinity Map). The corridor includes areas along the existing roadway approximately 0.4 miles north and south of the intersection of US Highway 501 and Shiloh Church Road. The corridor continues along Shiloh Church Road and/or Edwin Robertson Road until terminating at the Mega -Site. The corridor also includes the intersection of Chub Lake Road and Country Club Road. Waters along the corridor drain to Castle Creek, Fishing Creek and Marlowe Creek, respectively. This project is located within the Roanoke Watershed (HUC 03010104) (see Figure 2: Hydrologic Unit Code Map). The Site was delineated based upon the methodology outlined in the 1987 U.S. Army Corps of Engineers (USACE) Wetland Delineation Manual; the Regional Supplement to the Corps of Engineers Wetland Delineation Manual: Eastern Mountains and Piedmont Supplement (Version 2.0) and subsequently issued USACE regulatory guidance regarding the identification of jurisdictional stream channels through the recognition of field indicators of an ordinary high water mark within drainage features. Additionally, stream delineation techniques were used based on methodology outlined in the 2010 North Carolina Division of Water Quality (DWQ) Stream Determination Manual; Methodology for Identification of Intermittent and Perennial Streams and Their Origins (Version 4.11). Using this methodology, preliminary delineation mapping was produced and is included as Figure 4: Preliminary Jurisdictional Waters of the U.S. Delineation Map. During our delineation, a total of approximately 632 linear feet (LF) of perennial (R3) stream and 835 LF of intermittent (R4) stream were identified onsite. In addition, one palustrine forested wetland was identified in the floodplain of Marlowe Creek. Representative field data sheets were completed along each reach in order to document the presence or absence of all stream parameters. These data stations are included as Appendix A: Field Data Stations. Timmons Group would appreciate your review of the enclosed maps and attachments, and confirmation of the Person County Transportation Corridor Waters of the U.S. delineation. Please feel free to contact me at (919) 866-4500, or anna.reusche(a-)timmons.com if you have any questions or would like to schedule a Site visit to confirm the jurisdictional boundaries. CIVIL ENGINEERING I ENVIRONMENTAL I SURVEYING I GIS I LANDSCAPE ARCHITECTURE I CONSTRUCTION SERVICES Sincerely, Timmons Group Anna Reusche Environmental Project Manager Enclosures MAPS Figure 1 Vicinity Map Figure 2 Hydrologic Unit Code Map Figure 3 Environmental Inventory Maps Figure 4 Parcel Map Figure 5 NRCS Soil Survey Figure 6 Waters of the U.S. Delineation Map ATTACHMENTS Appendix A Field Data Sheets Appendix B Preliminary Jurisdictional Determination Form Appendix C USACE Jurisdictional Determination Request Appendix D Agent Authorization Forms MAPS Path: R:\805\39329 Person County MegaSite\GIS\Common Shared Exhibits\39329-VIC.mxd Feet r PERSON COUNTY MEGA -SITE T I M M O N S GROUP PERSON COUNTY, NORTH CAROLINA FIGURE 1: VICINITY MAP YOUR VISION ACHIEVED THROUGH OURS. TIMMONS GROUP JOB NUMBER: 39329 U.S.G.S. QUADRANGLE(S): ROXBORO PROJECT STUDY LIMITS: 114.2 ACRES DATE(S): 2016 LATITUDE: 36.489123 WATERSHED(S): LOWER DAN LONGITUDE: -78.952700 HYDROLOGIC UNIT CODE(S): 03010104 mited to construction, bidding, and/or construction staking without the express written consent of TIM MONS GROUP. r= of, 24 _ _cnz (3 ' o N Nu , ri 03020102 -1 LU U �r�tn�r ender n I'•. E U Z i=itij�rlrl F~ .. � x W E VY 'i 0 w � O � S Er 03010101- ? O Reek ingharri y H J kesdale 9109I,9109ft 0301 ALL' T w0 O ? � • w:rh O . Summerfield rL x 1. ID O Z z 2 K a o � 00 yak Ftir1 p L ,F._ Occaneec hl U N rcIJao _ U LUUj a 03010105 = o W Site Marker 03030002 rT r. a mg 2 Z g `yenryr ■ ■ ■ ■ a Burlington 03010102 Ch e City V L0 w r , I aanshnrn - fiIII;L rcrtl,:tll Hydrologic Unit Code.; A C c v N d - JOB NUMBER Miles 7� G'ufli 3i�i SH EET SHEET NO. ,i r l art 11i • .I I I? . I -It I I B, , v �) 111 Pivot 03010106 a o� w 03010103 _ IfDATE J h g w 11/1412017 DRAWN BY 03010104 : L. MAJOR DESIGNED BY /' .. C l n M l -a _ { jo rr L. MAJOR CHECKED BY lj Reservoir A.REUSCHE ILL ti VIRGINIA VIRGINIASCALE 1 " = 7 MILES = NORTH [;.Ah';JLI '-: Barr Latae Sta � Eden tacreatioriAre, Sappony 5dtsa .`i r~fyca Lake 03010106 e °�y 03010102 03010103 DLU Q Yarn-e;' i11a 03010104 — r= _ _cnz (3 ' o s'1 ri 03020102 -1 LU U ender n U Z i=itij�rlrl F~ � x � S Er s ? O Reek ingharri y H J kesdale 9109I,9109ft �+ O ? � Summerfield 03020101 Z z 2 z 00 yak Ftir1 p L ,F._ Occaneec hl U N Legend Saponi Sdtsa LUUj a W Site Marker 03030002 03020201 Butner _ a (' ■ ■ ■ ■ a Burlington F'fe l_ ar-I .11 ■ Lower Dan (03010104) I aanshnrn - fiIII;L rcrtl,:tll Hydrologic Unit Code.; 0 3.5 7 14 - JOB NUMBER Miles 7� G'ufli 3i�i SH EET SHEET NO. ,i x E W N M 07 M +J L x W a� L 0 VJ c 0 E E 0 U U) 0 i cn co a� c 0 U c 0 U) L ^0 LL 0) N M 07 M Ln O co L co d Legend w IN ■ NONEProject Study Limits - 114.2 Acres Person County Tax Parcels aP .. S 000 G' S.,. -�:ai q, ( ANN - t.. it d - WA Chub Lake Ra = - � � l 90 Hifi,- x. '� '°�',.; '•i2; 4 87 5 86 7 I Etlwin�Ro 78 81 80 79 82 83 84 13 12 10 74 9 Slhiloh�Chur�h Roa � �n�Rd 13 77 � 76 73 . 72 b� 75 14 18 A 17 L N �r Q o 1, iG' Qi L1J = Ra Q W p LLILLI U LL.� a LL U o� z o o O ` a< o ;ryfiill►Ri/ _ c a C/LL- audlHa/ a za �X F -U c, ® Q O U- W y a4ae� v � o p ap�a o LO L z - I ao O e•�" c3D1 �� O 00 W � � C �+ 01 ow N �Y+Y 40 _ � t 39 F LU 20 38 V p Q r 31 G1 37 42 O > DATE 19 21 28 36tp`' oC 11/15/2017 Shi/oh�Ch - 28 032 DRAWN BY 35 44 ss L. MAJOR �} 23 24 25 26 45 70 21 67 27 29 30 33 34 46 DESIGNED BY �; 47 L. MAJOR 71 sa sh/,. r 48 _R CHECKED BY law• 65 hJrChur�h�Rd 59 0 ' 49 A. REUSCHE S .. 62 60 58 m SCALE J 66 fi1 50 = 1 �� 800 C 55 51 . 52 d Z J ' lie d LU U i = J i r UJ O ! rr,ijr W 1 F. LL �� Vii'• i �� '� - NOTES: 1. PROJECT STUDY LIMITS ARE APPROXIMATE. 2. TAX PARCELS SOURCED FROM PERSON COUNTY. IDENT ML OWNER NAME 1 0909-00 8 164.000 ETREE LLC 2 0909-00545744.000 ETREE LLC 3 0909-00-72285.000 WAGSTAFF LINDSAY III & JOHN H 4 0909-00-64-9762.000 PHELPS CHRISTOPHER R & AMANDA 5 0909-00-77-2118.000 ETREE LLC 6 0909-00-97-1367.000 ETREE LLC 7 0919-00-06-0747.000 LEWIS L MICHAEL 8 0919-00-07-2534.000 ROBERTSON CROWDER JR TRST ETAL 9 0919-00-17-5232.000 ROBERTSON CROWDER & WALTER TRS 10 0919-00-27-0380.000 MITCHELL DEBORAH DORA 11 0919-00-27-2672.000 CAVALIER DEBORAH M 12 0919-00-27-4165.000 OAKLEY & SON INC 13 0919-00-39-7577.000 MONAGHAN DANIEL P & LAURA W 14 0919-00-48-2565.000 MONAGHAN DANIEL & LAURA WHAREY 15 0919-00-37-4182.000 NELSON LINDA & SHELLY LARIMER 16 0919-0037-0347.000 1 BLACK HARRY C ESTATE / LUTZ DEBORAH BLACK 17 0919-00-46-0994.000 IBURKS MARGARET H & OTHERS 18 0010-0050-1023.000 BERRYHILL EUGENE C JR & JOSEPH 19 0919-00-79-2607.000 BAILEY BARBARA A 20 0010-00-80-3287.000 BERRYHILL JOSEPH & EUGENE C 21 0919-00-99-6117.000 BAILEY BARBARA A 22 0020-00-00-5578.000 WILKINS JESSE JR/WILKINS JAMES 23 0929-00-18-3511.000 WILKINS ROBERT D & DEBORAH T 24 0929-00-18-5486.000 NELSON JAMES D 25 0929-00-18-6594.000 SNEAD TAMMY C/MICHAEL W PARHAM 26 0929-00-18-8478.000 SNEAD TAMMY C/MICHAEL W PARHAM 27 0929-00-28-0436.000 HOLT WILLIAM D 28 0929-00-37-8671.000 CARVER BUMPASS & CARVER INC 29 0929-00-28-4440.000 BROWN GARY BENJAMIN & KRIST B 30 0929-00-38-0386.000 SHILOH PRIMITIVE BAPTIST CHURC 31 0929-00-39-7544.000 HOWARD GERALDINE TRUSTEEE 32 0929-00-38-5677.000 HOWARD GERALDINE TRUSTEE 33 0929-00-38-8714.000 HOWARD GERALDINE TRUSTEE 34 0929-00-48-1619.000 HOWARD GERALDINE TRUSTEE 35 0929-00-49-2134.000 HOWARD GERALDINE TRUSTEE 36 0929-00-49-3442.000 MORTON LINWOOD STANLEY & NENA 37 0929-00-49-3596.000 MORTON LINWOOD STANLEY & NENA 38 0929-00-49-4750.000 BOWES KENNETH C 39 0020-00-40-6512.000 EAKER DAVID 40 0020-00-50-0358.000 DAVIS LARRY DEAN 41 0020-00-40-9169.000 WILKINS ANTHONY C & JANET L 42 0929-00-69-5238.000 PEED DOYLE & PEED DURWOOD 43 0929-00-49-8423.000 PRICE BILLY L & ANN T 5 44 0929-00-49-7138.000 CARVER BUMPASS CARVER INC 45 0929-00-49-6084.000 CARVER BUMPASS CARVER INC 46 0929-00-48-6920.000 CARVER BUMPASS CARVER INC J 47 0929-00-48-5776.000 CARVER BUMPASS & CARVER INC 48 0929-00-48-5613.000 CARVER BUMPASS CARVER INC 49 0929-00-48-4479.000 CARVER BUMPASS CARVER INC 50 0929-00-47-3604.000 BRIGGS BILLY MICHAEL & NANCY T j 51 0929-00-47-2481.000 THORNBURG DORINE 52 0929-00-47-2292.000 THORNBURG DORINE J 53 0929-00-65-3785.000 WINSTEAD MARY E MERRITT TRUSTE j 54 0929-00-35-9952.000 WINSTEAD MARY E MERRITT TRUSTE 55 0929-00-27-9451.000 FOX RICHARD EARL & TERESA H j 56 0929-00-37-8142.000 CLAYTON DAVID G & FRANCES H 57 0929-00-37-8672.000 FOX RICHARD & TERESA H J 58 0929-00-38-9120.000 FOX RICHARD EARL & TERESA H ) 59 0929-00-48-0229.000 DAY WALTER RALEIGH III & OTHER 3 60 0929-00-27-6974.000 ROGERS VAN MARTIN & DOROTHY I j 61 0929-00-28-4021.000 WILSON DONNIE EARL & MARY E 62 0929-00-27-2988.000 KNOTT JAMES E II & WENDY H : 63 0929-00-16-5247.000 WINSTEAD J MERRITT 64 0929-00-08-9284.000 HARPER BRIAN K & MAYNELL J 65 0929-00-08-7228.000 WILKINS JAMES BRADSHER 66 0929-00-07-5748.000 EASTWOOD HOWARD L & DONNA W ! 67 0929-00-08-4452.000 WILKINS JAMES B 68 0919-00-88-9976.000 POWERS JESSE KEITH & TAMMERA D ) 69 0919-00-74-6411.000 HALLS AGRI BUSINESS LLC 70 0919-00-89-2185.000 WOODSDALE FIRE DEPARTMENT INC 71 0919-00-78-1369.000 PULLIAM JAMES A & HOLLY P 72 0919-00-26-9992.000 SMITH EVELYN W UE 73 0919-00-26-8592.000 SMITH EVELYN W UE 74 0919-00-27-8015.000 WALKER ROBERT L & OTHERS j 75 0919-00-26-4509.000 RAMSEY ALBERT& SALLEY EST 76 0919-00-26-4915.000 OAKLEY & SON INC 77 0919-00-16-8883.000 ANDRADE MICHAEL A & LINDA C 78 0919-00-16-1760.000 ROBERTSON MAURICE J 79 0919-00-16-2454.000 RANSOM DELORIS B 80 0919-00-06-6444.000 RANSOM DELORIS & REVERDY C i 81 0919-00-06-2415.000 BRINSON DORIS FAYE 82 0909-00-96-9253.000 BRINSON DORIS FAYE 83 0909-00-95-5975.000 JAMES JOHN J & JULIA A 84 0909-00-95-3567.000 J & J INVESTMENTS & SALES INC 85 0909-00-93-7908.000 PARKER DANITA BROOKS 86 0909-00-84-0761.000 WILLIAMS HESTER MRS & OTHERS ) 87 0909-00-85-3692.000 WARREN JUDY EST 88 0909-00-40-4723.000 WAGSTAFF LINDSAY T JR & JOHN H 89 0908-17-11-6694.000 RILEY DOLORES W 90 0908-17-31-1220.000 WARREN R TCOMPANY INC 3 aP .. S 000 G' S.,. -�:ai q, ( ANN - t.. it d - WA Chub Lake Ra = - � � l 90 Hifi,- x. '� '°�',.; '•i2; 4 87 5 86 7 I Etlwin�Ro 78 81 80 79 82 83 84 13 12 10 74 9 Slhiloh�Chur�h Roa � �n�Rd 13 77 � 76 73 . 72 b� 75 14 18 A 17 L N �r Q o 1, iG' Qi L1J = Ra Q W p LLILLI U LL.� a LL U o� z o o O ` a< o ;ryfiill►Ri/ _ c a C/LL- audlHa/ a za �X F -U c, ® Q O U- W y a4ae� v � o p ap�a o LO L z - I ao O e•�" c3D1 �� O 00 W � � C �+ 01 ow N �Y+Y 40 _ � t 39 F LU 20 38 V p Q r 31 G1 37 42 O > DATE 19 21 28 36tp`' oC 11/15/2017 Shi/oh�Ch - 28 032 DRAWN BY 35 44 ss L. MAJOR �} 23 24 25 26 45 70 21 67 27 29 30 33 34 46 DESIGNED BY �; 47 L. MAJOR 71 sa sh/,. r 48 _R CHECKED BY law• 65 hJrChur�h�Rd 59 0 ' 49 A. REUSCHE S .. 62 60 58 m SCALE J 66 fi1 50 = 1 �� 800 C 55 51 . 52 d Z J ' lie d LU U i = J i r UJ O ! rr,ijr W 1 F. LL �� Vii'• i �� '� - WW ., ": * KLw W E ir _ - •� � V r' ih� 4 11 S IN+ �=��, •x � � � '*�'+� } � { 'sem I f .,�' N II - _ e : "ti,,_ f{Y� Ate• _ IQ' -n m . P -e,. - ,� N' 7n •e , IN h. J�• �� • Y - > Y . ice, . �: � ...-..,. VVk DD J r7• l Ar - - T� - r' , �• i !' " 1 '.rte _,—_. - _ _ �' ? .1 — _ 'Tic - q'y em's' p A� � - A � 'fir` qpm r • , dr .� fes: n moi? :i.Pi� g M ylr 1 YS Tr°'T _ 'v•% • - - " G - •'amu - Yp 9 � ,a r'_.r _ I• •e. y • I .. � � !_ iNy' �' ::911 � L- i' � -., _ _ .. _ ... _ - - .�' A�Y ! ' i .. •Y9.E::t7 _ drys ^J e .00 Lf mob. ' •�'q'�--' 1 wul nX '+fir I yy -HrY - YI Y' e+ WPI - S7 W'�9 � L .. N i. � � .® I -SI �,.•� Y'1 �' HrrI u c. r 1 - - • r F • , �_- �, .. �y, • r• F1' jr e x e91' .. - r . :e I �F - a 3k - :F' � C - NII • 5 1.- • - � � ! +� � T : 'i .NSI - �' - , If MLO�I'�' S I yam. �- "yal' i b a - �a my: r'I t i ° - .I wkF y •S i 1 - yµ-�� .= r 5' S �_• .r 9A��{ i�6Aryy� i�'9y� I yYl. Fri p f'.➢ . I -� i _ 1 1�Ll 0. !4 9` B , .. PI 1 r N I , Lg ia _ •s I . , jaiTim L� IL GeB „ 1 ` W EI � Rif - � L/ - - - y- ,r Y 4 � - 9' i- 6 ' � tee• s - . - •'' - . r-,=" _ _ J ?__ �'�. 'E.I.i I 11^^ VJ N kU N Lo Q W ' a � 0 L QW W U M O O O a Q"" c a za �X F-- LnU QU LL LU a�U c00 Q ��LJ z Ln N i W 00 N W LU e~ 7 O x � O Q LU = � Q a O > a� DATE 1 11/14/2017 DRAWN BY L. MAJOR J DESIGNED BY L. MA JOR _ CHECKED BY A. REUSCHE !SCALE 1 — 850/ -OB w 'l1I , .•9 �1 rY f Vim. 1 �' :11 ,, •�, Y � � � Via._ _ � _ - ����1 '�` � - — r F 1 TAD Ta IJ 16 I I,010 Ui :lid I � H - �� - �, N� Store d d - �-� F. �• Q _ Y z r TsE _ - 1r T. I a -1 I " . 1. .. .➢ Jr"� . irk" -0 Y 9.4 '` ! _ y _ U) 6 1�• � - �=� '• '� I _ L 96 i a F 7 m ti� n; a Vl • � -" :•.1'i• .1. . G_ �• 'ate _ �1• - AG e- -h' ^ -. G, - _ Z \ (�� x - - i or st). Z Z 'f� a I Ln Tal LL Go I Ie N i +"13 LU ` �+ _ 1L... a lTtr i A V Ii a fp p 1 �.101 y 4 s. tiff F3Y, `.• - ; LL W E I Y Ui • ,R N f _� 1 �-:I��Ile • .. e -B I " O G a G, 1A 2 4 F GOB -_ al= y r Ir• Project Limits are approximate. -° ;r ! Web soil survey from NRCS. .. '% •_..a,L.. a ..-•mIM r .114 ..11^ 1 1• �.. C • 5 _ y a • ui i is � - �• eAM �y1 d - we -+ rn N P„� aA- k - Legend M JOB NO . MLO 0 850 1,700 3,400 39329 00 i •,- - ; it + Q ems' �.J� Project Study Limits - 114.2 Acres # r Feet ]". SHEET NO. I..- ter.. I - ly 1 - _ _ 1 r iil '.y e6 7.3: ... 'xl .-J moi- - fil r• °. rl err - f - v N' N �fY:.Ia1�� �Vi� 6. ,...--..� L I •'r—ii �� �•4'N•i'" rr�-. � 4 -- •.. 'x .. CL •it+-. c 0 E E 0 U U) 0 i cn co a� c c 0 U c 0 E E 0 U U) 0 i cn co a� c c 0 U 21101-3 21E1-1 21101-2 _.r:' 1% Ve PMO Lin 3L Fl. .4e p -4,P IF:P7 i 21101-3 21E1-1 21101-2 _.r:' 1% Ve PMO Lin 3L Fl. .4e p -4,P APPENDIX A FIELD DATA SHEETS NC DWQ Stream Identification Form Version 4.11 Person County Mega -Site Transportation Corridor Date: 11/7/2017 Project/Site: Stream C (Castle Creek) Latitude: 36.4925 Evaluator: A. Reusche, Timmons Group County: Person County Longitude: -78.9449 Total Points: 35.5 Stream Determination circle one) Other ROXBORO Stream is at least intermittent Ephemeral Intermittent lPerennial e.g. Quad Name: if >_ 19 or perennial if >_ 30" 2 3 A. Geomorphology (Subtotal = 19.5 ) Absent Weak Moderate Strong 1aContinuity of channel bed and bank 0 1 2 3 2. Sinuosity of channel alongthalweg 0 1 2 3 3. In -channel structure: ex. riffle -pool, step -pool, ripple -pool sequence 0 1 2 3 - 4. Particle size of stream substrate 0 1 2 3 5. Active/relictfloodplain 0 1 2 3 6. Depositional bars or benches 0 1 2 3 7. Recent alluvial deposits 0 1 2 3 8. Headcuts 0 1 2 3 9. Grade control 0 0.5 1 1.5 10. Natural valley 0 0.5 1 1.5 11. Second or greater order channel No = 0 Yes = 3 a artificial ditches are not rated; see discussions in manual B. Hydrology (Subtotal = 8 ) 12. Presence of Baseflow 0 1 2 3 13. Iron oxidizing bacteria 0 1 2 3 14. Leaf litter 1.5 1 0.5 0 15. Sediment on plants or debris 0 0.5 1 1.5 16. Organic debris lines or piles 0 1 0.5 1 1 1.5 17. Soil -based evidence of high watertable? No = 0 Yes = 3 1 1 C. Biology (Subtotal = 8 18. Fibrous roots in stream bed 3 2 1 0 19. Rooted upland plants in streambed 3 2 1 0 20. Macrobenthos (note diversity and abundance) 0 1 2 3 21. Aquatic Mollusks 0 1 2 3 22. Fish 0 0.5 1 1 1.5 23. Crayfish 0 0.5 1 1.5 24. Amphibians 0 0.5 1 1.5 25. Algae 0 0.5 1 1.5 26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 Other = 0 'perennial streams may also be identified using other methods. See p. 35 of manual. Notes: No benthic species observed, but are assumed present based on good instream habitat. Sketch: NC DWQ Stream Identification Form Version 4.11 Person County Mega -Site Transportation Corridor Date: 11/7/2017 Project/Site: Stream D Latitude: 36.4911 Evaluator: A. Reusche, Timmons Group County: Person County Longitude: -78.9472 Total Points: 20 Stream Determination (circle one) Other ROXBORO Stream is at least intermittent Ephemeral Intermitten Perennial e.g. Quad Name: if >_ 19 or perennial if >_ 30" 2 3 A. Geomorphology (Subtotal =7.5 ) Absent Weak Moderate Strong 1aContinuity of channel bed and bank 0 1 2 3 2. Sinuosity of channel alongthalweg 0 1 2 3 3. In -channel structure: ex. riffle -pool, step -pool, ripple -pool sequence 0 1 - 2 3 4. Particle size of stream substrate 0 1 2 3 5. Active/relictfloodplain 0 1 2 3 6. Depositional bars or benches 0 1 2 3 7. Recent alluvial deposits 0 1 2 3 8. Headcuts 0 1 2 3 9. Grade control 0 0.5 1 1.5 10. Natural valley 0 0.5 1 1.5 11. Second or greater order channel No = 0 Yes = 3 Sketch: a artificial ditches are not rated; see discussions in manual B. Hydrology (Subtotal = 6.5 ) 12. Presence of Baseflow 0 1 2 3 13. Iron oxidizing bacteria 0 1 2 3 14. Leaf litter 1.5 1 0.5 0 15. Sediment on plants or debris 0 0.5 1 1.5 16. Organic debris lines or piles 0 1 0.5 1 1 1.5 17. Soil -based evidence of high watertable? 0 No = 0 Yes = 3 1.5 C. Biology (Subtotal = 6 18. Fibrous roots in stream bed 3 2 1 0 19. Rooted upland plants in streambed 3 2 1 0 20. Macrobenthos (note diversity and abundance) 0 1 2 3 21. Aquatic Mollusks 0 1 2 3 22. Fish 0 0.5 1 1 1.5 23. Crayfish 0 0.5 1 1.5 24. Amphibians 0 0.5 1 1.5 25. Algae 0 0.5 1 1.5 26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 Other = 0 'perennial streams may also be identified using other methods. See p. 35 of manual. Notes: Sketch: NC DWQ Stream Identification Form Version 4.11 Person County Mega -Site Transportation Corridor Date: 11/7/2017 Project/Site: Stream E Latitude: 36.4911 Evaluator: A. Reusche, Timmons Group County: Person County Longitude: -78.9472 Total Points: 20 Stream Determination (circle one) Other ROXBORO Stream is at least intermittent Ephemeral Intermitten Perennial e.g. Quad Name: if >_ 19 or perennial if >_ 30" 2 3 A. Geomorphology (Subtotal =7.5 ) Absent Weak Moderate Strong 1aContinuity of channel bed and bank 0 1 2 3 2. Sinuosity of channel alongthalweg 0 1 2 3 3. In -channel structure: ex. riffle -pool, step -pool, ripple -pool sequence 0 1 - 2 3 4. Particle size of stream substrate 0 1 2 3 5. Active/relictfloodplain 0 1 2 3 6. Depositional bars or benches 0 1 2 3 7. Recent alluvial deposits 0 1 2 3 8. Headcuts 0 1 2 3 9. Grade control 0 0.5 1 1.5 10. Natural valley 0 0.5 1 1.5 11. Second or greater order channel No = 0 Yes = 3 Sketch: a artificial ditches are not rated; see discussions in manual B. Hydrology (Subtotal = 6.5 ) 12. Presence of Baseflow 0 1 2 3 13. Iron oxidizing bacteria 0 1 2 3 14. Leaf litter 1.5 1 0.5 0 15. Sediment on plants or debris 0 0.5 1 1.5 16. Organic debris lines or piles 0 1 0.5 1 1 1.5 17. Soil -based evidence of high watertable? 0 No = 0 Yes = 3 1.5 C. Biology (Subtotal = 6 18. Fibrous roots in stream bed 3 2 1 0 19. Rooted upland plants in streambed 3 2 1 0 20. Macrobenthos (note diversity and abundance) 0 1 2 3 21. Aquatic Mollusks 0 1 2 3 22. Fish 0 0.5 1 1 1.5 23. Crayfish 0 0.5 1 1.5 24. Amphibians 0 0.5 1 1.5 25. Algae 0 0.5 1 1.5 26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 Other = 0 'perennial streams may also be identified using other methods. See p. 35 of manual. Notes: Sketch: NC DWQ Stream Identification Form Version 4.11 Person County Mega -Site Transportation Corridor Date: 11/7/2017 Project/Site: Stream F Latitude: 36.4901 Evaluator: A. Reusche, Timmons Group County: Person County Longitude: -78.9521 Total Points: 32.5 Stream Determination circle one) Other ROXBORO Stream is at least intermittent Ephemeral Intermittent JPerennial e.g. Quad Name: if >_ 19 or perennial if >_ 30" 2 3 A. Geomorphology (Subtotal = 16.5 ) Absent Weak Moderate Strong 1aContinuity of channel bed and bank 0 1 2 3 2. Sinuosity of channel alongthalweg 0 1 2 3 3. In -channel structure: ex. riffle -pool, step -pool, ripple -pool sequence 0 1 2 3 - 4. Particle size of stream substrate 0 1 2 3 5. Active/relictfloodplain 0 1 2 3 6. Depositional bars or benches 0 1 2 3 7. Recent alluvial deposits 0 1 2 3 8. Headcuts 0 1 2 3 9. Grade control 0 0.5 1 1.5 10. Natural valley 0 0.5 1 1.5 11. Second or greater order channel Sketch: No = 0 Yes = 3 a artificial ditches are not rated; see discussions in manual B. Hydrology (Subtotal = 8 ) 12. Presence of Baseflow 0 1 2 3 13. Iron oxidizing bacteria 0 1 2 3 14. Leaf litter 1.5 1 0.5 0 15. Sediment on plants or debris 0 0.5 1 1.5 16. Organic debris lines or piles 0 1 0.5 1 1 1.5 17. Soil -based evidence of high watertable? No = 0 Yes = 3 1 1 C. Biology (Subtotal = 8 18. Fibrous roots in stream bed 3 2 1 0 19. Rooted upland plants in streambed 3 2 1 0 20. Macrobenthos (note diversity and abundance) 0 1 2 3 21. Aquatic Mollusks 0 1 2 3 22. Fish 0 0.5 1 1 1.5 23. Crayfish 0 0.5 1 1.5 24. Amphibians 0 0.5 1 1.5 25. Algae 0 0.5 1 1.5 26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 Other = 0 'perennial streams may also be identified using other methods. See p. 35 of manual. Notes: No benthic species observed, but are assumed present based on good instream habitat. Sketch: NC DWQ Stream Identification Form Version 4.11 Person County Mega -Site Transportation Corridor Date: 11/7/2017 Project/Site: Stream G Latitude: 36.4895 Evaluator: A. Reusche, Timmons Group County: Person County Longitude: -78.9505 Total Points: 32.5 Stream Determination circle one) Other ROXBORO Stream is at least intermittent Ephemeral Intermittent JPerennial e.g. Quad Name: if >_ 19 or perennial if >_ 30" 2 3 A. Geomorphology (Subtotal = 16.5 ) Absent Weak Moderate Strong 1aContinuity of channel bed and bank 0 1 2 3 2. Sinuosity of channel alongthalweg 0 1 2 3 3. In -channel structure: ex. riffle -pool, step -pool, ripple -pool sequence 0 1 2 3 - 4. Particle size of stream substrate 0 1 2 3 5. Active/relictfloodplain 0 1 2 3 6. Depositional bars or benches 0 1 2 3 7. Recent alluvial deposits 0 1 2 3 8. Headcuts 0 1 2 3 9. Grade control 0 0.5 1 1.5 10. Natural valley 0 0.5 1 1.5 11. Second or greater order channel Sketch: No = 0 Yes = 3 a artificial ditches are not rated; see discussions in manual B. Hydrology (Subtotal = 8 ) 12. Presence of Baseflow 0 1 2 3 13. Iron oxidizing bacteria 0 1 2 3 14. Leaf litter 1.5 1 0.5 0 15. Sediment on plants or debris 0 0.5 1 1.5 16. Organic debris lines or piles 0 1 0.5 1 1 1.5 17. Soil -based evidence of high watertable? No = 0 Yes = 3 1 1 C. Biology (Subtotal = 8 18. Fibrous roots in stream bed 3 2 1 0 19. Rooted upland plants in streambed 3 2 1 0 20. Macrobenthos (note diversity and abundance) 0 1 2 3 21. Aquatic Mollusks 0 1 2 3 22. Fish 0 0.5 1 1 1.5 23. Crayfish 0 0.5 1 1.5 24. Amphibians 0 0.5 1 1.5 25. Algae 0 0.5 1 1.5 26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 Other = 0 'perennial streams may also be identified using other methods. See p. 35 of manual. Notes: No benthic species observed, but are assumed present based on good instream habitat. Sketch: NC DWQ Stream Identification Form Version 4.11 Person County Mega -Site Transportation Corridor Date: 11/7/2017 Project/Site: Stream H Latitude: 36.4821 Evaluator: A. Reusche, Timmons Group County: Person County Longitude: -78.9827 Total Points: 16.5 Stream Determination (circle one) Other ROXBORO Stream is at least intermittent E hemeral Intermittent Perennial e.g. Quad Name: if >_ 19 or perennial if >_ 30" 2 3 A. Geomorphology (Subtotal = 6 ) Absent Weak Moderate Strong 1aContinuity of channel bed and bank 0 1 2 3 2. Sinuosity of channel alongthalweg 0 1 2 3 3. In -channel structure: ex. riffle -pool, step -pool, ripple -pool sequence 0 - 1 2 3 4. Particle size of stream substrate 0 1 2 3 5. Active/relictfloodplain 0 1 2 3 6. Depositional bars or benches 0 1 2 3 7. Recent alluvial deposits 0 1 2 3 8. Headcuts 0 1 2 3 9. Grade control 0 0.5 1 1.5 10. Natural valley 0 0.5 1 1.5 11. Second or greater order channel No = 0 Yes = 3 Sketch: a artificial ditches are not rated; see discussions in manual B. Hydrology (Subtotal = 4.5 ) 12. Presence of Baseflow 0 1 2 3 13. Iron oxidizing bacteria 0 1 2 3 14. Leaf litter 1.5 1 0.5 0 15. Sediment on plants or debris 0 0.5 1 1.5 16. Organic debris lines or piles 0 1 0.5 1 1 1.5 17. Soil -based evidence of high watertable? 0 No = 0 Yes = 3 1.5 C. Biology (Subtotal = 6 18. Fibrous roots in stream bed 3 2 1 0 19. Rooted upland plants in streambed 3 2 1 0 20. Macrobenthos (note diversity and abundance) 0 1 2 3 21. Aquatic Mollusks 0 1 2 3 22. Fish 0 0.5 1 1 1.5 23. Crayfish 0 0.5 1 1.5 24. Amphibians 0 0.5 1 1.5 25. Algae 0 0.5 1 1.5 26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 Other = 0 'perennial streams may also be identified using other methods. See p. 35 of manual. Notes: Sketch: NC DWQ Stream Identification Form Version 4.11 Person County Mega -Site Transportation Corridor Date: 11/7/2017 Project/Site: Stream J (Fishing Br.) Latitude: 36.4834 Evaluator: A. Reusche, Timmons Group County: Person County Longitude: -78.9786 Total Points: 25 Stream Determination (circle one) Other ROXBORO Stream is at least intermittent Ephemeral Intermitten Perennial e.g. Quad Name: if >_ 19 or perennial if >_ 30" 2 3 A. Geomorphology (Subtotal = 12.5 ) Absent Weak Moderate Strong 1aContinuity of channel bed and bank 0 1 2 3 2. Sinuosity of channel alongthalweg 0 1 2 3 3. In -channel structure: ex. riffle -pool, step -pool, ripple -pool sequence 0 1 - 2 3 4. Particle size of stream substrate 0 1 2 3 5. Active/relictfloodplain 0 1 2 3 6. Depositional bars or benches 0 1 2 3 7. Recent alluvial deposits 0 1 2 3 8. Headcuts 0 1 2 3 9. Grade control 0 0.5 1 1.5 10. Natural valley 0 0.5 1 1.5 11. Second or greater order channel No = 0 Yes = 3 a artificial ditches are not rated; see discussions in manual B. Hydrology (Subtotal = 6.5 ) 12. Presence of Baseflow 0 1 2 3 13. Iron oxidizing bacteria 0 1 2 3 14. Leaf litter 1.5 1 0.5 0 15. Sediment on plants or debris 0 0.5 1 1.5 16. Organic debris lines or piles 0 1 0.5 1 1 1.5 17. Soil -based evidence of high watertable? 0 No = 0 Yes = 3 1.5 C. Biology (Subtotal = 6 18. Fibrous roots in stream bed 3 2 1 0 19. Rooted upland plants in streambed 3 2 1 0 20. Macrobenthos (note diversity and abundance) 0 1 2 3 21. Aquatic Mollusks 0 1 2 3 22. Fish 0 0.5 1 1 1.5 23. Crayfish 0 0.5 1 1.5 24. Amphibians 0 0.5 1 1.5 25. Algae 0 0.5 1 1.5 26. Wetland plants in streambed FACW = 0.75; OBL = 1.5 Other = 0 'perennial streams may also be identified using other methods. See p. 35 of manual. Notes: Appears to be flowing from farm pond located upslope adjacent to farm road. Stream does not continue to Mainstem of Castle Creek. Sketch: WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region Project/Site: Person County Mega -Site, Transportation Corridor City/County: Person County Sampling Date: 11 /7/2017 Applicant/Owner: PCBIC State: NC Sampling Point: 1 -UP Investigator(s): A. Reusche, Timmons Section, Township, Range: Landform (hillslope, terrace, etc.): Floodplain Local relief (concave, convex, none): None Subregion (LRR or MLRA): LRR-P Lat: 36.4831 Long: -78.9808 Soil Map Unit Name: Chewacla and Wehadkee soils NWI classification: NA Are climatic / hydrolo is conditions on the site typical for this time of year? Yes _�✓ No Q (If no, explain in Remarks.) Are Vegetation Soil= or Hydrology ❑ significantly disturbed? Are "Normal Circumstances" present? Yes 0 No ❑ Are Vegetation= Soil =, or Hydrology,= naturally problematic? (If needed, explain any answers in Remarks.) Slope (%): Datum: SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc. Hydrophytic Vegetation Present? Yes = No = Is the Sampled Area Hydric Soil Present? Yes= N= within a Wetland? Yes = No Wetland Hydrology Present? Yes.= No Remarks: Upland point taken in between wetland and Marlowe Creek, in area of raised levee. HYDROLOGY Wetland Hydrology Indicators: Secondary Indicators (minimum of two required) Primary Indicators (minimum of one is required; check all that apply) ❑ Surface Soil Cracks (B6) ❑ Surface Water (Al) ❑ True Aquatic Plants (1314) ❑ Sparsely Vegetated Concave Surface (B8) ❑ High Water Table (A2) ❑ Hydrogen Sulfide Odor (Cl) 1__I Drainage Patterns (B10) ❑ Saturation (A3) ❑ Oxidized Rhizospheres on Living Roots (C3) 1__I Moss Trim Lines (B16) ❑ Water Marks (B1) ❑ Presence of Reduced Iron (C4) ❑ Dry -Season Water Table (C2) ❑ Sediment Deposits (B2) ❑ Recent Iron Reduction in Tilled Soils (C6) ❑ Crayfish Burrows (C8) ❑ Drift Deposits (B3) ❑ Thin Muck Surface (C7) ❑ Saturation Visible on Aerial Imagery (C9) ❑ Algal Mat or Crust (B4) ❑ Other (Explain in Remarks) ❑ Stunted or Stressed Plants (D1) ❑ Iron Deposits (135) ❑ Geomorphic Position (D2) ❑ Inundation Visible on Aerial Imagery (B7) ❑ Shallow Aquitard (D3) ❑ Water -Stained Leaves (B9) ❑ Microtopographic Relief (D4) _F_1 Aquatic Fauna (B13) ❑ FAC -Neutral Test (D5) Field Observations: Surface Water Present? Yes ❑ No ❑ Depth (inches): Water Table Present? Yes ❑ No ❑ Depth (inches): ❑ ❑ n Saturation Present? Yes No Depth (inches): Wetland Hydrology Present? Yes No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: Remarks: US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0 VEGETATION (Five Strata) — Use scientific names of plants. Sampling Point: I -UP Tree Stratum (Plot size: 30 ) 1. Diospyros virginiana 2. Liriodendron tulipifera 3. Fraxinus pennsylvanica 4. 5 6. Absolute % Cover 40 30 15 85 Dominant Indicator Species? Status Y FAC Y FACU N FAC = Total Cover Dominance Test worksheet: Number of Dominant Species That Are OBL, FACW, or FAC: 5 (A) Total Number of Dominant Species Across All Strata: 9 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 55 (A/B) Prevalence Index worksheet: 50% of total cover: 42.5 20% of total cover: 17 Total % Cover of: Multiply by: 15 OBL species x 1 = Sapling Stratum (Plot size: ) FACW species x 2 - 1. Diospyros virginiana 20 Y FAC 2. Liriodendron tulipifera 10 Y FACU FAC species x 3 = 3_ Fraxinus pennsylvanica 10 Y FAC FACU species x 4 = UPL species x 5 = 4. Column Totals: (A) (B) 5. 6. Prevalence Index = B/A = 40 = Total Cover Hydrophytic Vegetation Indicators: 50% of total cover: 20 20% of total cover: 8 ❑ 1 - Rapid Test for Hydrophytic Vegetation Shrub Stratum (Plot size: 15 ) 0 2 - Dominance Test is >50% 1 Ligustrum sinense 40 v FACU ❑ 3 - Prevalence Index is 153.01 ❑ 4 - Morphological Adaptations' (Provide supporting 2 data in Remarks or on a separate sheet) 3. ❑ Problematic Hydrophytic Vegetation' (Explain) 4 'Indicators of hydric soil and wetland hydrology must 6• be present, unless disturbed or problematic. 40 = Total Cover Definitions of Five Vegetation Strata: 50% of total cover: 20 20% of total cover: 8 Tree - Woody plants, excluding woody vines, Herb Stratum (Plot size: 5 ) approximately 20 ft (6 m) or more in height and 3 in. 1. Microstegium vimineum 30 Y FAC (7.6 cm) or larger in diameter at breast height (DBH). 2• Sapling - Woody plants, excluding woody vines, 3• approximately 20 ft (6 m) or more in height and less than 3 in. (7.6 cm) DBH. 5. Shrub - Woody plants, excluding woody vines, 6 approximately 3 to 20 ft (1 to 6 m) in height. 7• Herb - All herbaceous (non -woody) plants, including $ herbaceous vines, regardless of size, and woody plants, except woody vines, less than approximately 3 9 ft (1 m) in height. 10. 11. Woody vine - All woody vines, regardless of height. 30 = Total Cover 50% of total cover: 15 20% of total cover: 6 Woody Vine Stratum (Plot size: 30 ) 1. Toxicodenron radicans 20 Y FAC 3. 4. Hydrophytic 20 = Total Cover Vegetation 50% of total cover: 10 20% of total cover: 4 Present? Yes n No� Remarks: (Include photo numbers here or on a separate sheet.) US Army Corps of Engineers Eastern Mountains and Piedmont - Version 2.0 SOIL Sampling Point: 1 -UP Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix Redox Features (inches) Color (moist) % Color (moist) % Type' LoC Texture Remarks 0-12+ 10YR 5/4 100 CL Clay Loam 'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pare Lininq, M=Matrix Hydric Soil Indicators: Indicators for Problematic Hydric Soils3: ❑ Histosol (Al) ❑ Dark Surface (S7) ❑ 2 cm Muck (A10) (MLRA 147) ❑ Histic Epipedon (A2) ❑ Polyvalue Below Surface (S8) (MLRA 147, 148) ❑ Coast Prairie Redox (A16) ❑ Black Histic (A3) ❑ Thin Dark Surface (S9) (MLRA 147, 148) (MLRA 147, 148) ❑ Hydrogen Sulfide (A4) ❑ Loamy Gleyed Matrix (F2) ❑ Piedmont Floodplain Soils (F19) ❑ Stratified Layers (A5) ❑ Depleted Matrix (F3) (MLRA 136, 147) ❑ 2 cm Muck (A10) (LRR N) ❑ Redox Dark Surface (F6) ❑ Very Shallow Dark Surface (TF1 2) ❑ Depleted Below Dark Surface (A11) ❑ Depleted Dark Surface (F7) ❑ Other (Explain in Remarks) ❑ Thick Dark Surface (Al2) ❑ Redox Depressions (F8) Sandy Mucky Mineral (S1) (LRR N, ❑ Iron -Manganese Masses (F12) (LRR N, MLRA 147, 148) MLRA 136) ❑ Sandy Gleyed Matrix (S4) ❑ Umbric Surface (F13) (MLRA 136, 122) 31ndicators of hydrophytic vegetation and ❑ Sandy Redox (S5) ❑ Piedmont Floodplain Soils (F19) (MLRA 148) wetland hydrology must be present, ❑ Stripped Matrix (S6) ❑ Red Parent Material (F21) (MLRA 127, 147) unless disturbed or problematic. Restrictive Layer (if observed): Type Depth (inches): Remarks: Hydric Soil Present? Yes El No E US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0 WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont Region Project/Site: Person County Mega -Site, Transportation Corridor City/County: Person County Sampling Date: 11 /7/2017 Applicant/Owner: PCBIC State: NC Sampling Point: I -WET Investigator(s): A. Reusche, Timmons Section, Township, Range: Landform (hillslope, terrace, etc.): Floodplain Local relief (concave, convex, none): None Slope (%): 2 Subregion (LRR or MLRA): LRR P Lat: 36.4831 Long: -78.9808 Datum: NAD 1983 Soil Map Unit Name: Chewacla and Wehadkee soils NWI classification: PFO Are climatic / hydrolo is conditions on the site typical for this time of year? Yes _�✓ No Q (If no, explain in Remarks.) Are Vegetation Soil= or Hydrology ❑ significantly disturbed? Are "Normal Circumstances" present? Yes 0 No ❑ Are Vegetation= Soil =, or Hydrology,= naturally problematic? (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc. Hydrophytic Vegetation Present? Yes = No = Is the Sampled Area Hydric Soil Present? Yes= N= within a Wetland? Yes = No Wetland Hydrology Present? Yes. ✓= No Remarks: Wetland I is located in the floodplain of Marlowe Creek. System is separated from creek by large berm. HYDROLOGY Wetland Hydrology Indicators: Secondary Indicators (minimum of two required) Primary Indicators (minimum of one is required; check all that apply) ❑ Surface Soil Cracks (B6) ❑ Surface Water (Al) ❑ True Aquatic Plants (1314) ❑ Sparsely Vegetated Concave Surface (B8) ❑ High Water Table (A2) ❑ Hydrogen Sulfide Odor (Cl) ❑✓ Drainage Patterns (B10) ❑ Saturation (A3) ❑✓ Oxidized Rhizospheres on Living Roots (C3) 1__I Moss Trim Lines (B16) ✓❑ Water Marks (B1) ❑ Presence of Reduced Iron (C4) ❑ Dry -Season Water Table (C2) ❑✓ Sediment Deposits (B2) ❑ Recent Iron Reduction in Tilled Soils (C6) ❑✓ Crayfish Burrows (C8) ❑ Drift Deposits (B3) ❑ Thin Muck Surface (C7) ❑ Saturation Visible on Aerial Imagery (C9) ❑ Algal Mat or Crust (B4) ❑ Other (Explain in Remarks) ❑ Stunted or Stressed Plants (D1) ❑ Iron Deposits (135) ❑✓ Geomorphic Position (D2) ✓❑ Inundation Visible on Aerial Imagery (B7) ❑ Shallow Aquitard (D3) ,Q Water -Stained Leaves (B9) ❑✓ Microtopographic Relief (D4) _F_1 Aquatic Fauna (B13) ❑✓ FAC -Neutral Test (D5) Field Observations: Surface Water Present? Yes ❑ No= Depth (inches): Water Table Present? Saturation Present? Yes ❑ No 0 Depth (inches): Yes ❑ No= Depth (inches): Wetland Hydrology Present? Yes n No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: Remarks: US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0 VEGETATION (Five Strata) — Use scientific names of plants. 5. 6. 100 = Total Cover 50% of total cover: 50 20% of total cover: 20 Sapling Stratum (Plot size: 15 ) 1. Quercus phellos 20 Y FAC 2. Fraxinus pennsylvanica 10 Y FAC'; 4. 5. Sampling Point: I -WET Dominance Test worksheet: Number of Dominant Species That Are OBL, FACW, or FAC: 6 (A) Total Number of Dominant Species Across All Strata: 8 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 75 (A/B) Prevalence Index worksheet: Absolute Dominant Indicator Tree Stratum (Plot size: 30 ) % Cover Species? Status 1. Quercus phellos 40 Y FAC 2. Fraxinus pennsylvanica 30 Y FAC'_ 3. Liriodendron tulipifera 20 Y FACU A Acer rubrum 10 N FAC 5. 6. 100 = Total Cover 50% of total cover: 50 20% of total cover: 20 Sapling Stratum (Plot size: 15 ) 1. Quercus phellos 20 Y FAC 2. Fraxinus pennsylvanica 10 Y FAC'; 4. 5. Sampling Point: I -WET Dominance Test worksheet: Number of Dominant Species That Are OBL, FACW, or FAC: 6 (A) Total Number of Dominant Species Across All Strata: 8 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 75 (A/B) Prevalence Index worksheet: Total % Cover of: Multiply by: OBL species x 1 = FACW species x 2 = FAC species x 3 = FACU species x 4 = UPL species x 5 = Column Totals: (A) (B) 6. Prevalence Index = B/A = 30 = Total Cover Hydrophytic Vegetation Indicators: 50% of total cover: 15 20% of total cover: 6 ❑ 1 - Rapid Test for Hydrophytic Vegetation Shrub Stratum (Plot size: 15 ) 0 2 - Dominance Test is >50% 1 Ligustrum sinense 20 v FACU ❑ 3 - Prevalence Index is 153.01 2 ❑ 4 - Morphological Adaptations' (Provide supporting 3. data in Remarks or on a separate sheet) 4 ❑ Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must 6• be present, unless disturbed or problematic. 20 = Total Cover Definitions of Five Vegetation Strata: 50% of total cover: 10 20% of total cover: 4 Tree — Woody plants, excluding woody vines, Herb Stratum (Plot size: 5 ) approximately 20 ft (6 m) or more in height and 3 in. 1. Microstegium vimineum 50 Y FAC (7.6 cm) or larger in diameter at breast height (DBH). 2• Sapling — Woody plants, excluding woody vines, 3• approximately 20 ft (6 m) or more in height and less than 3 in. (7.6 cm) DBH. 5. Shrub — Woody plants, excluding woody vines, 6 approximately 3 to 20 ft (1 to 6 m) in height. 7• Herb — All herbaceous (non -woody) plants, including $ herbaceous vines, regardless of size, and woody plants, except woody vines, less than approximately 3 9 ft (1 m) in height. 10. 11. Woody vine — All woody vines, regardless of height. 50 = Total Cover 50% of total cover: 25 20% of total cover: 10 Woody Vine Stratum (Plot size: 30 ) 1. Toxicodendron radicans 20 Y FAC 3. 4. Hydrophytic 20 = Total Cover Vegetation 50% of total cover: 10 20% of total cover: 4 Present? Yes n No� Remarks: (Include photo numbers here or on a separate sheet.) US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0 SOIL Sampling Point: I -WET Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix Redox Features (inches) Color (moist) % Color (moist) % Type' LoC Texture Remarks 0-12+ 10YR 5/3 40 10YR 5/6 60 C PL SL Sandy Loam (redox present) 'Type: C=Concentration, D=Depletion, RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pare Lininq, M=Matrix Hydric Soil Indicators: Indicators for Problematic Hydric Soils3: ❑ Histosol (Al) ❑ Dark Surface (S7) ❑ 2 cm Muck (A10) (MLRA 147) ❑ Histic Epipedon (A2) ❑ Polyvalue Below Surface (S8) (MLRA 147, 148) ❑ Coast Prairie Redox (A16) ❑ Black Histic (A3) ❑ Thin Dark Surface (S9) (MLRA 147, 148) (MLRA 147, 148) ❑ Hydrogen Sulfide (A4) ❑ Loamy Gleyed Matrix (F2) ❑ Piedmont Floodplain Soils (F19) ❑ Stratified Layers (A5) ❑ Depleted Matrix (F3) (MLRA 136, 147) ❑ 2 cm Muck (A10) (LRR N) ❑ Redox Dark Surface (F6) ❑ Very Shallow Dark Surface (TF1 2) ❑ Depleted Below Dark Surface (A11) ❑ Depleted Dark Surface (F7) ❑ Other (Explain in Remarks) ❑ Thick Dark Surface (Al2) Redox Depressions (F8) Sandy Mucky Mineral (S1) (LRR N, ❑ Iron -Manganese Masses (F12) (LRR N, MLRA 147, 148) MLRA 136) ❑ Sandy Gleyed Matrix (S4) ❑ Umbric Surface (F13) (MLRA 136, 122) 31ndicators of hydrophytic vegetation and ❑ Sandy Redox (S5) ❑ Piedmont Floodplain Soils (F19) (MLRA 148) wetland hydrology must be present, ❑ Stripped Matrix (S6) ❑ Red Parent Material (F21) (MLRA 127, 147) unless disturbed or problematic. Restrictive Layer (if observed): Type Depth (inches): Remarks: Hydric Soil Present? Yes E No El US Army Corps of Engineers Eastern Mountains and Piedmont — Version 2.0 APPENDIX B PRELIMINARY JURIDICTIONAL DETERMINATION FORM Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM BACKGROUND INFORMATION A. REPORT COMPLETION DATE FOR PJD: B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Person County Business and Industrial Center, Inc. C. DISTRICT OFFICE, FILE NAME, AND NUMBER: SAW -2016-02542 D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION: (USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR AQUATIC RESOURCES AT DIFFERENT SITES) State: NC County/parish/borough: Person City: Roxboro Center coordinates of site (lat/long in degree decimal format): Lat.: 36.4915 Long.: -78.9466 Universal Transverse Mercator: Name of nearest waterbody: Castle Creek E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY): ❑ Office (Desk) Determination. Date: ❑ Field Determination. Date(s): TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY JURISDICTION. Site number Latitude (decimal degrees) Longitude (decimal degrees) Estimated amount of aquatic resource in review area (acreage and linear feet, if applicable) Type of aquatic resource (i.e., wetland vs. non -wetland waters) Geographic authority to which the aquatic resource "may be" subject (i.e., Section 404 or Section 10/404) I ) The Corps of Engineers believes that there may be jurisdictional aquatic resources in the review area, and the requestor of this PJD is hereby advised of his or her option to request and obtain an approved JD (AJD) for that review area based on an informed decision after having discussed the various types of JDs and their characteristics and circumstances when they may be appropriate. 2) In any circumstance where a permit applicant obtains an individual permit, or a Nationwide General Permit (NWP) or other general permit verification requiring "pre - construction notification" (PCN), or requests verification for a non -reporting NWP or other general permit, and the permit applicant has not requested an AJD for the activity, the permit applicant is hereby made aware that: (1) the permit applicant has elected to seek a permit authorization based on a PJD, which does not make an official determination of jurisdictional aquatic resources; (2) the applicant has the option to request an AJD before accepting the terms and conditions of the permit authorization, and that basing a permit authorization on an AJD could possibly result in less compensatory mitigation being required or different special conditions; (3) the applicant has the right to request an individual permit rather than accepting the terms and conditions of the NWP or other general permit authorization; (4) the applicant can accept a permit authorization and thereby agree to comply with all the terms and conditions of that permit, including whatever mitigation requirements the Corps has determined to be necessary; (5) undertaking any activity in reliance upon the subject permit authorization without requesting an AJD constitutes the applicant's acceptance of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered individual permit) or undertaking any activity in reliance on any form of Corps permit authorization based on a PJD constitutes agreement that all aquatic resources in the review area affected in any way by that activity will be treated as jurisdictional, and waives any challenge to such jurisdiction in any administrative or judicial compliance or enforcement action, or in any administrative appeal or in any Federal court; and (7) whether the applicant elects to use either an AJD or a PJD, the JD will be processed as soon as practicable. Further, an AJD, a proffered individual permit (and all terms and conditions contained therein), or individual permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331. If, during an administrative appeal, it becomes appropriate to make an official determination whether geographic jurisdiction exists over aquatic resources in the review area, or to provide an official delineation of jurisdictional aquatic resources in the review area, the Corps will provide an AJD to accomplish that result, as soon as is practicable. This PJD finds that there "may be"waters of the U.S. and/or that there "may be" navigable waters of the U.S. on the subject review area, and identifies all aquatic features in the review area that could be affected by the proposed activity, based on the following information: SUPPORTING DATA. Data reviewed for PJD (check all that apply) Checked items should be included in subject file. Appropriately reference sources below where indicated for all checked items: ■❑ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor: Vicinity. Aerial, Environmental Inventory Map, HUG Map, USGS, i Soil Survey, and Waters of the U.S. Delineation Map Map: 0 Data sheets prepared/submitted by or on behalf of the PJD requestor. ❑ Office concurs with data sheets/delineation report. ❑ Office does not concur with data sheets/delineation report. Rationale: ❑ Data sheets prepared by the Corps: ❑ Corps navigable waters' study: ■❑ U.S. Geological Survey Hydrologic Atlas: ❑ USGS NHD data. 0 USGS 8 and 12 digit HUC maps. ■❑ U.S. Geological Survey map(s). Cite scale & quad name: Olive Hill and Roxboro 0 Natural Resources Conservation Service Soil Survey. Citation: Person County (1995) ❑ National wetlands inventory map(s). Cite name: ❑ State/local wetland inventory map(s): ■❑ FEMA/FIRM maps: ❑ 100 -year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929) ■❑ Photographs: ■❑ Aerial (Name & Date): or ❑■ Other (Name & Date): Site Photos (11/6/17) ■❑ Previous determination(s). File no. and date of response letter: SAW -2017-01877 (waterline, Project Site) ❑ Other information (please specify): IMPORTANT NOTE: The information recorded on this form has not necessarily been verified by the Corps and should not be relied upon for later jurisdictional determinations. Signature and date of Regulatory staff member completing PJD Signature and date of person requesting PJD (REQUIRED, unless obtaining the signature is impracticable)' 1 Districts may establish timeframes for requestor to return signed PJD forms. If the requestor does not respond within the established time frame, the district may presume concurrence and no additional follow up is necessary prior to finalizing an action. Site number Latitude (decimal degrees) Longitude (decimal degrees) Estimated amount of aquatic resource in review areas (acreage and linear feet) Type of aquatic resource (i.e. wetland vs. non -wetland waters) Geographic authority tow is the aquatic resource "may be" subject (i.e Section 404 or Section 10/404) C 36.4925 -78.9449 62 non -wetland water Section 404 D 36.4911 -78.9472 60 non -wetland water Section 404 E 36.4911 -78.9472 640 non -wetland water Section 404 F 36.4901 -78.9521 340 non -wetland water Section 404 G 36.4895 -78.9505 230 non -wetland water Section 404 H 36.4821 -78.9827 229 non -wetland water Section 404 1 36.4831 -78.9808 0.25 wetland Section 404 J 36.4834 -78.9786 135 non -wetland water Section 404 Marlowe Creek 36.4834 -78.97861 1751 non -wetland waterl Section 404 APPENDIX C PRELIMINARY JURIDICTIONAL DETERMINATION FORM urisdictional Determination Request US Army Corps of Engineers Wilmington District This form is intended for use by anyone requesting a jurisdictional determination (JD) from the U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting information, as described within each category, with your request. You may submit your request via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project manager of the county in which the property is located. A current list of project managers by assigned counties can be found on-line at: http://www.saw.usace.army.mil/Missions/Re ug latoI3 PerinitPro2ram/Contact/CouniyLocator.awx, by calling 910-251-4633, or by contacting any of the field offices listed below. Once your request is received you will be contacted by a Corps project manager. ASHEVILLE & CHARLOTTE REGULATORY FIELD OFFICES US Army Corps of Engineers 151 Patton Avenue, Room 208 Asheville, North Carolina 28801-5006 General Number: (828) 271-7980 Fax Nuinber: (828) 281-8120 RALEIGH REGULATORY FIELD OFFICE US Army Corps of Engineers 3331 Heritage Trade Drive, Suite 105 Wake Forest, North Carolina 27587 General Number: (919) 554-4884 Fax Number: (919) 562-0421 INSTRUCTIONS: WASHINGTON REGULATORY FIELD OFFICE US Army Corps of Engineers 2407 West Fifth Street Washington, North Carolina 27889 General Number: (910) 251-4610 Fax Number: (252) 975-1399 WILMINGTON REGULATORY FIELD OFFICE US Army Corps of Engineers 69 Darlington Avenue Wilmington, North Carolina 28403 General Number: 910-251-4633 Fax Number: (910) 251-4025 All requestors must complete Parts A, B, C, D, E, F and G. NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a paying client or your agency, please note the specific submittal requirements in Part H. NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that all JD requests must include the current property owner authorization for the Corps to proceed with the determination, which may include inspection of the property when necessary. This form must be signed by the current property owner(s) or the owner(s) authorized agent to be considered a complete request. NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for JD requests associated with North Carolina Department of Transportation (NCDOT) projects will be conducted according to the current NCDOT/USACE protocols. NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD may not be valid for the wetland conservation provisions of the Food Security Act of 1985. If you or your tenant are USDA Program participants, or anticipate participation in USDA programs, you should also request a certified wetland determination from the local office of the Natural Resources Conservation Service, prior to starting work. Version: May 2017 Page 1 Jurisdictional Determination Request A. PARCEL INFORMATION Street Address: See attached parcel m City, State: County: Parcel Index Number(s) (PIN): B. REQUESTOR INFORMATION Name: Anna Reusche. Timmons Grou Mailing Address: 5410 Trinity Road Telephone Number: Electronic Mail Address: Select one: ✓❑ Raleigh NC 27529 C: 919-816-7745 anna.reusche@timmons.com I am the current property owner. I am an Authorized Agent or Environmental Consultant' Interested Buyer or Under Contract to Purchase Other, please explain. C. PROPERTY OWNER INFORMATION' Name: See attached parcel map Mailing Address: Telephone Number: Electronic Mail Address: Must provide completed Agent Authorization Form/Letter. z Documentation of ownership also needs to be provided with request (copy of Deed, County GTS/Parcel/Tax Record). Version: May 2017 Page 2 Jurisdictional Determination Request D. PROPERTY ACCESS CERTIFICATION' 4 By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps) to enter upon the property herein described for the purpose of conducting on- site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the undersigned, am either a duly authorized owner of record of the property identified herein, or acting as the duly authorized agent of the owner of record of the property. Anna Reusche Print Name Capacity: ❑ Owner Z Authorized Agent' 11/20/17 Date Signature E. REASON FOR JD REQUEST: (Check as many as applicable) ❑ I intend to construct/develop a project or perform activities on this parcel which would be designed to avoid all aquatic resources. ❑ I intend to construct/develop a project or perform activities on this parcel which would be designed to avoid all jurisdictional aquatic resources under Corps authority. ❑ I intend to construct/develop a project or perform activities on this parcel which may require authorization from the Corps, and the JD would be used to avoid and minimize impacts to jurisdictional aquatic resources and as an initial step in a future permitting process. ❑✓ I intend to construct/develop a projector perform activities on this parcel which may require authorization from the Corps; this request is accompanied by my pen -nit application and the JD is to be used in the permitting process. ❑ i intend to construct/develop a project or perform activities in a navigable water of the U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of the tide. A Corps JD is required in order obtain my local/state authorization. I intend to contest jurisdiction over a particular aquatic resource and request the Corps confirm that jurisdiction does/does not exist over the aquatic resource on the parcel. ❑ T believe that the site may be comprised entirely of dry land. ❑ Other: For NCDOT requests following the current NCDOT[USACE protocols, skip to Part E. a If there arc multiple parcels owned by different parties, please provide the following for each additional parcel on a continuation sheet. 5 Must provide agent authorization form/letter signed by owner(s). Version: May 2017 Page 3 Jurisdictional Determination Request F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One) W1I am requesting that the Corps provide a preliminarX JD for the property identified herein. A Preliminary Jurisdictional Determination (PJD) provides an indication that there may be "waters of the United States" or "navigable waters of the United States"on a property. PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all waters and wetlands on the property will be treated as if they are jurisdictional "waters of the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is "preliminary" in the sense that an approved JD can be requested at any time. PJDs do not expire. ❑ I am requesting that the Corps provide an approved JD for the property identified herein. An Approved Jurisdictional Determination (AJD) is a determination that jurisdictional "waters of the United States" or "navigable waters of the United States" are either present or absent on a site. An approved JD identifies the limits of waters on a site determined to be jurisdictional under the Clean Water Act and/or Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be posted on the Corps website. A landowner, permit applicant, or other "affected party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years (subject to certain limited exceptions explained in Regulatory Guidance Letter 05- 02). ❑ I am unclear as to which JD I would like to request and require additional information to inform my decision. G. ALL REQUESTS ❑v Map of Property or Project Area. This Map must clearly depict the boundaries of the review area. ✓❑ Size of Property or Review Area 114 acres. ❑ The property boundary (or review area boundary) is clearly physically marked on the site. Version: May 2017 Page 4 Jurisdictional Determination Request H. REQUESTS FROM CONSULTANTS Project Coordinates (Decimal Degrees): Latitude: 36.4779 Longitude: -78.9941 A legible delineation map depicting the aquatic resources and the property/review area. Delineation maps must be no larger than l lxl7 and should contain the following: (Corps signature of submitted survey plats will occur after the submitted delineation map has been reviewed and approved).' ■ North Arrow ■ Graphical Scale ■ Boundary of Review Area ■ Date ■ Location of data points for each Wetland Determination Data Form or tributary assessment reach. For Approved Jurisdictional Determinations: Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404 wetlands, etc. Please include the acreage of these features. Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries, impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary, open water, relatively permanent water, pond, etc. Please include the acreage or linear length of each of these features as appropriate. Isolated waters, waters that lack a significant nexus to navigable waters, or non - jurisdictional upland features should be identified as Non -Jurisdictional. Please include a justification in the label regarding why the feature is non jurisdictional (i.e. "Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage or linear length of these features as appropriate. For Preliminary Jurisdictional Determinations: Wetland and non -wetland features should not be identified as Jurisdictional, 404, Waters of the United States, or anything that implies jurisdiction. These features can be identified as Potential Waters of the United States, Potential Non -wetland Waters of the United States, wetland, stream, open water, etc. Please include the acreage and linear length of these features as appropriate. LJ Completed Wetland Determination Data Forms for appropriate region (at least one wetland and one upland form needs to be completed for each wetland type) Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the supplied map meets the necessary mapping standards. http://www.saw.usacc.2,M.mil/Missions/Regulatory-Permit- Pro gram/Jurisdiction/ Version: May 2017 Page 5 Jurisdictional Determination Request Completed appropriate Jurisdictional Determination form • PJDs, please complete a Preliminary Jurisdictional Determination Form and include the Aquatic Resource Table • AJDs, please complete an Approved Jurisdictional Detennination Form' Vicinity Map ❑ Aerial Photograph ❑ USGS Topographic Map ❑v Soi I Survey Map zOther Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site Plan, previous delineation maps, LiDAR maps, FEMA floodplain maps) ❑ Landscape Photos (if taken) F] NCSAM and/or NCWAM Assessment Forms and Rating Sheets ❑v NC Division of Water Resources Stream Identification Forms Other Assessment Forms 7 www.saw.usace.army.mil/Portals/59/docs/re ug latory/regdocs/JD/RGL_08-02_Apn A Prelim JD_ Form_fillable.pdf ' Please see http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Jurisdiction/ Principal Purpose: The information that you provide will be used in evaluating your request to determine whether there are any aquatic resources within the project area subject to federal jurisdiction under the regulatory authorities referenced above. Routine Uses: This information maybe shared with the Department of Justice and other federal, state, and local government agencies, and the public, and may be made available as part of a public notice as required by federal law. Your name and property location where federal jurisdiction is to be determined will be included in the approved jurisdictional determination (AJD), which will be made available to the public on the District's website and on the Headquarters USAGE website. Disclosure: Submission of requested information is voluntary; however, if information is not provided, the request for an AJD cannot be evaluated nor can an AJD be issued. Version: May 2017 Page 6 APPENDIX D AGENT AUTHORIZATION FORM