20191121 Ver 1_PJDPacket_20190821

Jurisdictional Determination Request
Version: May 2017 Page 1

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/RegulatoryPermitProgram/Contact/CountyLocator.aspx,
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: [phone]
Fax Number: [phone]

RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]

WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]

INSTRUCTIONS:
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.
Jurisdictional Determination Request
Version: May 2017 Page 2
A. PARCEL INFORMATION
Street Address: _______________________________________________
City, State: _______________________________________________
County:
Parcel Index Number(s) (PIN):
B. REQUESTOR INFORMATION
Name:
Mailing Address:
_________________________________________
Telephone Number: _________________________________________
Electronic Mail Address: ________________________________________
Select one:
I am the current property owner.
I am an Authorized Agent or Environmental Consultant1
Interested Buyer or Under Contract to Purchase
Other, please explain. ________________________________________
__________________________________________________________
C. PROPERTY OWNER INFORMATION2
Name:
Mailing Address:
Telephone Number:
Electronic Mail Address:
_______________________________________________________________________________________________________________________
1 Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Jurisdictional Determination Request
Version: May 2017 Page 3

D. PROPERTY ACCESS CERTIFICATION3,4

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.

Print Name
Capacity: Owner Authorized Agent5

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 project or perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit 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.
I believe that the site may be comprised entirely of dry land.
Other:___________________________________________________________________
_______________________________________________________________________
3 For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
4 If there are 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).
Jurisdictional Determination Request
Version: May 2017 Page 4

F. JURISDICTIONAL DETERMINATION (JD) TYPE (Select One)

I am requesting that the Corps provide a preliminary 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

Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.

Size of Property or Review Area acres.

The property boundary (or review area boundary) is clearly physically marked on the site.

Jurisdictional Determination Request
Version: May 2017 Page 5

H. REQUESTS FROM CONSULTANTS

Project Coordinates (Decimal Degrees): Latitude: ______________________
Longitude: ______________________

A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than 11x17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
 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.

Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)

____________________________________________________________________________
6 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.usace.army.mil/Missions/Regulatory-Permit-
Program/Jurisdiction/
Jurisdictional Determination Request
Version: May 2017 Page 6

Completed appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form7 and include the
Aquatic Resource Table
• AJDs, please complete an Approved Jurisdictional Determination Form8

Vicinity Map

Aerial Photograph

USGS Topographic Map

Soil Survey Map

Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)

Landscape Photos (if taken)

NCSAM and/or NCWAM Assessment Forms and Rating Sheets

NC Division of Water Resources Stream Identification Forms

Other Assessment Forms

_____________________________________________________________________________
7 www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/JD/RGL_08-02_App_A_Prelim_JD_Form_fillable.pdf
8 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 may be 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.
Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD:
B. NAME AND ADDRESS OF PERSON REQUESTING PJD:
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: County/parish/borough: City:
Center coordinates of site (lat/long in degree decimal format):
Lat.: Long.:
Universal Transverse Mercator:
Name of nearest waterbody:
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)
1) 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:
Map: ___________________________________________________.
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.
USGS 8 and 12 digit HUC maps.
U.S. Geological Survey map(s). Cite scale & quad name: _______________________________.
Natural Resources Conservation Service Soil Survey. Citation: ___________________________.
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): ____________________________________________.
Previous determination(s). File no. and date of response letter: __________________________.
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 Signature and date of
Regulatory staff member person requesting PJD
completing PJD (REQUIRED, unless obtaining
the signature is impracticable)1
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.
^_
^_Projec t L oca tion
SC ALE :
DATE :
PROJECT NUMBER
FIG URE N O.
11 " = 1 m ile
8-10 -19
4335 -19-042
CH A ND WO RT H STOR M D RA IN AG E IM PROVEM ENTAND STRE A M E NH AN C E ME NT P RO JE C TCHARLOTTE, M EC KL E NB U RG C OU NT Y, NORTH CA ROLIN ADrawing Path: T:\Projects\2019\ENV\001-050\4335-19-042 CoC 2019 Point Repair Projects (all)\GIS\ChandworthPCN\1_VICINITY.mxd plotted by DHomans 08-10-20190 1 2
Mile s
VICINITY MAP
³
Se r vice La ye r Cre dits: So u rc e s: Es ri, HE RE, G arm in, U SGS,Inte rm ap , I NC REM EN T P, N RC an , Esri Jap an , M ET I, EsriChina (H o ng K o ng), E sri K ore a, E sri (T h aila nd ), N GCC, (c)
FE M A 1 00 -Yea r F lo od Z on e
Ap p rox im ate P ro j ec t A re a
SC ALE :
DATE :
PROJECT NUMBER
FIG URE N O.
21 " = 2 ,00 0 '
8-8-19
4335 -19-042
CH A ND WO RT H STOR M D RA IN AG E IM PROVEM ENTAND STRE A M E NH AN C E ME NT P RO JE C TCHARLOTTE, M EC KL E NB U RG C OU NT Y, NORTH CA ROLIN ADrawing Path: T:\Projects\2019\ENV\001-050\4335-19-042 CoC 2019 Point Repair Projects (all)\GIS\ChandworthPCN\2_USGS_FEMA.mxd plotted by DHomans 08-08-20190 2,000 4,000
(FE ET)
USGS TOP OGRA PHIC MAP /FE MA FL OOD ZONE MA P
³
RE FE R EN CE : 1986 CHARLOTTE EA ST [NC ] USGS 1:24,000 QUAD SH EET MAPFEMA FLOOD Z ONE DATA OBTAINED FROM M ECKLENBURG COU NTY OP EN MAP PING.TH IS MA P IS FOR INFORMATIONAL P URP OSES ONLY. ALL F EATURE LOCATIONSDISPLAYED ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEYINFORMATION, UNLESS STATED OTH ERWISE.
Se r vice La ye r Cre dits: Co py righ t:© 2013 Na t ion alGeographic So c iety, i-c ub e d
K i t l e y P lBlowing Rock Wy
GardenClubLn
TyndaleAv
PembertonDr Severn AvFlowerfield RdSussexAvHar
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n AvWillowood DrRhodes AvBrookfieldDr
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C o nse r va to r y Ln
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S E E F I G . 5
Ap p rox im ate P ro j ect Area
Ob se r ve d Stre am Bank s
SC ALE :
DATE :
PROJECT NUMBER
FIG URE N O.
31 " = 2 50 '
8-8-19
4335 -19-042
CH A ND WO RT H STOR M D RA IN AG E IM PROVEM ENTAND STRE A M E NH AN C E ME NT P RO JE C TCHARLOTTE, M EC KL E NB U RG C OU NT Y, NORTH CA ROLIN ADrawing Path: T:\Projects\2019\ENV\001-050\4335-19-042 CoC 2019 Point Repair Projects (all)\GIS\ChandworthPCN\3_projectarea.mxd plotted by DHomans 08-08-20190 250 500
(FE ET)
PROJEC T A REA
³REFER EN CE : 20 18 AE RI AL PHOTOG RA PHTHIS MA P IS FOR INFOR MATIONA L P URP OSE S ONLY. A LLFEATURE LOCAT IONS D IS PL AYE D AR E A PPR OX IMAT ED. T HEY A R ENOT B AS ED ON CIVIL S UR VEY INFOR MATION, UNLE SS S TATE D
Se r vice La ye r Cre dits: me ckc o
!GIN LE T CHAN NELAPPROX. 55 LF INTERM IT TEN T CHA NN EL
4023
4026 4034
4015
4001
4018
4042
40074010 Inlet Channel (Intermitten t)
me ckc o
Stream Banks
Potential Non-Wetland Waters- Centerline
!G Stream D at a Point
SC ALE:
DATE:
PROJECT N UMBER
FIG URE N O.4
1 " = 2 0 '
8-10 -19
4335 -19-042E
Drawing Path: T:\Projects\2019\ENV\001-050\4335-19-042 CoC 2019 Point Repair Projects (all)\GIS\ChandworthPCN\4_JD.mxd plotted by DHomans 08-10-20190 20 40
(FEET)³CHANDWORTH STORM DRAINAGE IMPROVEMENTAND STREAM ENHANCEMENT PROJECTCHARLOTTE, MECKLENBURG COUNTY, NORTH CAROLINAPOTENTIAL WATERS OF THE U.S.:INLET CHANNELREFERENCE: 95% DESIGN PLANS : SHEET 495% DESIG N P LANS WERE OBTAINED F ROM CH ARLOTTE MECKLENBURG STORM WATERSERVICES AND DATED 3/4/2019. TH IS MAP IS FOR INF ORMATIONA L PURPOSES ONLY. A LLFEATURE LOCATIONS D ISPL AYED ARE APPROXIMATED. THEY A RE NOT BA SED ON CIVILSURVEY INF ORMATION, UNLESS STATED OTH ERWISE.
!G
OUT FALL CHANN ELAPPROX. 25 5 LF PERENN IA L CHA NN EL
Chandworth Rd
Outfall C hannel (Perennial)
me ckc o
Stream Banks
Potential Non-Wetland Waters- Centerline
!G Stream D at a Point
SC ALE:
DATE:
PROJECT N UMBER
FIG URE N O.5
1 " = 2 0 '
8-11 -19
4335 -19-042E
Drawing Path: T:\Projects\2019\ENV\001-050\4335-19-042 CoC 2019 Point Repair Projects (all)\GIS\ChandworthPCN\5_JD.mxd plotted by DHomans 08-11-20190 20 40
(FEET)
³CHANDWORTH STORM DRAINAGE IMPROVEMENTAND STREAM ENHANCEMENT PROJECTCHARLOTTE, MECKLENBURG COUNTY, NORTH CAROLINAPOTENTIAL WATERS OF THE U.S.:OUTFALL CHANNELREFERENCE: 95% DESIGN PLANS : SHEET 495% DESIG N P LANS WERE OBTAINED F ROM CH ARLOTTE MECKLENBURG STORM WATERSERVICES AND DATED 3/4/2019. TH IS MAP IS FOR INF ORMATIONA L PURPOSES ONLY. A LLFEATURE LOCATIONS D ISPL AYED ARE APPROXIMATED. THEY A RE NOT BA SED ON CIVILSURVEY INF ORMATION, UNLESS STATED OTH ERWISE.
Chandworth SDIP
Charlotte, North Carolina
S&ME Project No. 4335-19-042E

7/3/2019 Photographer: Dave Homans 1
Location / Orientation End of Chandworth Rd, looking southeast
Remarks View of outlet pipe origin of stream under Chandworth Rd.
` 7/3/2019 Photographer: Dave Homans 2
Location / Orientation End of Chandworth Rd, looking west
Remarks View of channel immediately downsteam of outfall, note fence
acting as a channel blockage.
Chandworth SDIP
Charlotte, North Carolina
S&ME Project No. 4335-19-042E

7/3/2019 Photographer: Dave Homans 3
Location / Orientation Downstream from Chandworth Rd, looking west
Remarks View of typical channel conditions.
7/3/2019 Photographer: Dave Homans 4
Location / Orientation Approx. 250 downstream from Chadworth Rd, looking west
Remarks View of section of channel with bedrock / boulder outcrop.
Chandworth SDIP
Charlotte, North Carolina
S&ME Project No. 4335-19-042E

6/20/2019 Photographer: Helen Simonson 5
Location / Orientation Behind 4015 Ashton Drive, looking northwest.
Remarks View of condition of channel and drop inlet / headwall
structure at the Inlet Channel data point.
6/20/2019 Photographer: Helen Simonson 6
Location / Orientation Behind 4015 Ashton Drive, looking southeast.
Remarks View of Inlet Channel intermittent stream, looking upstream.

NC Division of Water Quality –Methodology for Identification of Intermittent and
Perennial Streams and Their Origins v. 4.11

41

NC DWQ Stream Identification Form Version 4.11
Date: Project/Site: Latitude:
Evaluator: County: Longitude:
Total Points:
Stream is at least intermittent
if ≥ 19 or perennial if ≥ 30*
Stream Determination (circle one)
Ephemeral Intermittent Perennial
Other
e.g. Quad Name:

A. Geomorphology (Subtotal =_________) Absent Weak Moderate Strong
1a. Continuity of channel bed and bank 0 1 2 3
2. Sinuosity of channel along thalweg 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/relict floodplain 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 = _________)
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 0.5 1 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3
C. Biology (Subtotal = _________)
18. Fibrous roots in streambed 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 1.5
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:

7/3/2019 Chandworth SDIP
Dave Homans (S&ME,Inc.)Mecklenburg
35.134079
-80.848907
Perennial
Stream
Macrobenthos appeared impaired for channel size and condition.Dusky salamanders and
redbreast sunfish observed.
21
10.5
9
40.5
OUTFALL CHANNEL
Absent Weak Moderate Strong
1a. Continuity of channel bed and bank 0 1 2 3
2. Sinuosity of channel along thalweg 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/relict floodplain 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

NC DWQ Stream Identification Form Version 4.11
Date: 06/20/2018 Project/Site: 4015 Ashton Rd Latitude: 35.133
Evaluator: HMS County: Mecklenburg Longitude: -80.843
Total Points: 26
Stream is at least intermittent
if ≥ 19 or perennial if ≥ 30*
Stream Determination (circle one)
Ephemeral Intermittent Perennial
Other CLT East
e.g. Quad Name:

A. Geomorphology (Subtotal = 9 )

a artificial ditches are not rated; see discussions in manual
B. Hydrology (Subtotal = 10.5 _)
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 0.5 1 1.5
17. Soil-based evidence of high water table? No = 0 Yes = 3
C. Biology (Subtotal = 6.5 )
18. Fibrous roots in streambed 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 1.5
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:

WEATHER CONDITIONS DAY OF SAMPLE; Sunny. No rain last 24 hours. Part of Chandworth SDIP

INLET CHANNEL
NC SAM FIELD ASSESSMENT RESULTS
Accompanies User Manual Version 2.1
USACE AID #: NCDWR #:
INSTRUCTIONS: Attach a sketch of the assessment area and photographs. Attach a copy of the USGS 7.5 -minute topographic
quadrangle, and circle the location of the stream reach under evaluation. If multiple stream reaches will be evaluated on th e same property,
identify and number all reaches on the attached map, and include a separate form for each reach. See the NC SAM User Manual for
detailed descriptions and explanations of requested information. Record in the “Notes/Sketch” section if supplementary measurements were
performed. See the NC SAM User Manual for examples of additional measurements that may be relevant.
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
PROJECT/SITE INFORMATION:
1. Project name (if any): Chandworth-Upstream 2. Date of evaluation: 6/20/2018
3. Applicant/owner name: CSWS 4. Assessor name/organization: HMS
5. County: Mecklenburg 6. Nearest named water body
on USGS 7.5-minute quad: Little Sugar Creek 7. River basin: Catawba
8. Site coordinates (decimal degrees, at lower end of assessment reach): 35.133/ -80.843
STREAM INFORMATION: (depth and width can be approximations)
9. Site number (show on attached map): 4015 Ashton Rd 10. Length of assessment reach evaluated (feet): 50
11. Channel depth from bed (in riffle, if present) to top of bank (feet): 3 Unable to assess channel depth.
12. Channel width at top of bank (feet): 5 13. Is assessment reach a swamp steam? Yes No
14. Feature type: Perennial flow Intermittent flow Tidal Marsh Stream
STREAM CATEGORY INFORMATION:
15. NC SAM Zone: Mountains (M) Piedmont (P) Inner Coastal Plain (I) Outer Coastal Plain (O)
16. Estimated geomorphic
19 valley shape (skip for
Tidal Marsh Stream):
A B
(more sinuous stream, flatter valley slope) (less sinuous stream, steeper valley slope)
17. Watershed size: (skip Size 1 (< 0.1 mi2) Size 2 (0.1 to < 0.5 mi2) Size 3 (0.5 to < 5 mi2) Size 4 (≥ 5 mi2)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION:
18. Were regulatory considerations evaluated? Yes No If Yes, check all that apply to the assessment area.
Section 10 water Classified Trout Waters Water Supply Watershed (I II III IV V)
Essential Fish Habitat Primary Nursery Area High Quality Waters/Outstanding Resource Waters
Publicly owned property NCDWR Riparian buffer rule in effect Nutrient Sensitive Waters
Anadromous fish 303(d) List CAMA Area of Environmental Concern (AEC)
Documented presence of a federal and/or state listed protected species within the assessment area.
List species:
Designated Critical Habitat (list species)
19. Are additional stream information/supplementary measurements included in “Notes/Sketch” section or attached? Yes No

1. Channel Water – assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
A Water throughout assessment reach.
B No flow, water in pools only.
C No water in assessment reach.
2. Evidence of Flow Restriction – assessment reach metric
A At least 10% of assessment reach in-stream habitat or riffle-pool sequence is severely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes or ponded water or impoundment on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates , debris jams,
beaver dams).
B Not A
3. Feature Pattern – assessment reach metric
A A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
B Not A
4. Feature Longitudinal Profile – assessment reach metric
A Majority of assessment reach has a substantially altered stream profile (examples: channel down -cutting, existing damming,
over widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of
these disturbances).
B Not A
5. Signs of Active Instability – assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
active bank failure, active channel down-cutting (head-cut), active widening, and artificial hardening (such as concrete, gabion, rip-rap).
A < 10% of channel unstable
B 10 to 25% of channel unstable
C > 25% of channel unstable

INLET CHANNEL
6. Streamside Area Interaction – streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RB
A A Little or no evidence of conditions that adversely affect reference interaction
B B Moderate evidence of conditions (examples: berms, levees, down-cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of flood flows through streamside area,
leaky or intermittent bulkheads, causeways with floodplain constriction, minor ditching [including mosquito ditching])
C C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision,
disruption of flood flows through streamside area] or too much floodplain/intertidal zone access [examples:
impoundments, intensive mosquito ditching]) or floodplain/intertidal zone unnaturally absent or assessment reach is a
man-made feature on an interstream divide
7. Water Quality Stressors – assessment reach/intertidal zone metric
Check all that apply.
A Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
B Excessive sedimentation (burying of stream features or intertidal zone)
C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
D Odor (not including natural sulfide odors)
E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in “Notes/Sketch”
section.
F Livestock with access to stream or intertidal zone
G Excessive algae in stream or intertidal zone
H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc)
I Other: (explain in “Notes/Sketch” section)
J Little to no stressors
8. Recent Weather – watershed metric (skip for Tidal Marsh Streams)
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a
drought.
A Drought conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
B Drought conditions and rainfall exceeding 1 inch within the last 48 hours
C No drought conditions
9. Large or Dangerous Stream – assessment reach metric
Yes No Is stream is too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10. Natural In-stream Habitat Types – assessment reach metric
10a. Yes No Degraded in-stream habitat over majority of the assessment reach (examples of stressors include excessive
sedimentation, mining, excavation, in-stream hardening [for example, rip-rap], recent dredging, and snagging)
(evaluate for Size 4 Coastal Plain streams only, then skip to Metric 12)
10b. Check all that occur (occurs if > 5% coverage of assessment reach) (skip for Size 4 Coastal Plain streams)
A Multiple aquatic macrophytes and aquatic mosses
(include liverworts, lichens, and algal mats)
B Multiple sticks and/or leaf packs and/or emergent
vegetation
C Multiple snags and logs (including lap trees)
D 5% undercut banks and/or root mats and/or roots
in banks extend to the normal wetted perimeter
E Little or no habitat
F 5% oysters or other natural hard bottoms
G Submerged aquatic vegetation
H Low-tide refugia (pools)
I Sand bottom
J 5% vertical bank along the marsh
K Little or no habitat

*********************************REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS****************************
11. Bedform and Substrate – assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
11a. Yes No Is assessment reach in a natural sand-bed stream? (skip for Coastal Plain streams)
11b. Bedform evaluated. Check the appropriate box(es).
A Riffle-run section (evaluate 11c)
B Pool-glide section (evaluate 11d)
C Natural bedform absent (skip to Metric 12, Aquatic Life)
11c. In riffle sections, check all that occur below the normal wetted perimeter of the assessment reach – whether or not submerged.
Check at least one box in each row (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams). Not Present (NP) =
absent, Rare (R) = present but < 10%, Common (C) = > 10-40%, Abundant (A) = > 40-70%, Predominant (P) = > 70%. Cumulative
percentages should not exceed 100% for each assessment reach.
NP R C A P
Bedrock/saprolite
Boulder (256 – 4096 mm)
Cobble (64 – 256 mm)
Gravel (2 – 64 mm)
Sand (.062 – 2 mm)
Silt/clay (< 0.062 mm)
Detritus
Artificial (rip-rap, concrete, etc.)
11d. Yes No Are pools filled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
Check for Tidal Marsh Streams Only
12. Aquatic Life – assessment reach metric (skip for Tidal Marsh Streams)
12a. Yes No Was an in-stream aquatic life assessment performed as described in the User Manual?
If No, select one of the following reasons and skip to Metric 13. No Water Other:
12b. Yes No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check all that
apply. If No, skip to Metric 13.
1 >1 Numbers over columns refer to “individuals” for Size 1 and 2 streams and “taxa” for Size 3 and 4 streams.
Adult frogs
Aquatic reptiles
Aquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
Beetles
Caddisfly larvae (T)
Asian clam (Corbicula)
Crustacean (isopod/amphipod/crayfish/shrimp)
Damselfly and dragonfly larvae
Dipterans
Mayfly larvae (E)
Megaloptera (alderfly, fishfly, dobsonfly larvae)
Midges/mosquito larvae
Mosquito fish (Gambusia) or mud minnows (Umbra pygmaea)
Mussels/Clams (not Corbicula)
Other fish
Salamanders/tadpoles
Snails
Stonefly larvae (P)
Tipulid larvae
Worms/leeches
13. Streamside Area Ground Surface Condition – streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB). Consider storage capacity with regard to both overbank flow and upland
runoff.
LB RB
A A Little or no alteration to water storage capacity over a majority of the streamside area
B B Moderate alteration to water storage capacity over a majority of the streamside area
C C Severe alteration to water storage capacity over a majority of the streamside area (examples: ditches, fill, soil
compaction, livestock disturbance, buildings, man-made levees, drainage pipes)
14. Streamside Area Water Storage – streamside area metric (skip for Size 1 streams, Tidal Marsh Streams, and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
A A Majority of streamside area with depressions able to pond water ≥ 6 inches deep
B B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
C C Majority of streamside area with depressions able to pond water < 3 inches deep
15. Wetland Presence – streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB). Do not consider wetlands outside of the streamside area or within the normal
wetted perimeter of assessment reach.
LB RB
Y Y Are wetlands present in the streamside area?
N N
16. Baseflow Contributors – assessment reach metric (skip for Size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
A Streams and/or springs (jurisdictional discharges)
B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
C Obstruction passing flow during low-flow periods within the assessment area (beaver dam, leaky dam, bottom-release dam, weir)
D Evidence of bank seepage or sweating (iron in water indicates seepage)
E Stream bed or bank soil reduced (dig through deposited sediment if present)
F None of the above
17. Baseflow Detractors – assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
B Obstruction not passing flow during low-flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
C Urban stream (≥ 24% impervious surface for watershed)
D Evidence that the streamside area has been modified resulting i n accelerated drainage into the assessment reach
E Assessment reach relocated to valley edge
F None of the above
18. Shading – assessment reach metric (skip for Tidal Marsh Streams)
Consider aspect. Consider “leaf-on” condition.
A Stream shading is appropriate for stream category (may include gaps associated with natural processes)
B Degraded (example: scattered trees)
C Stream shading is gone or largely absent
3
19. Buffer Width – streamside area metric (skip for Tidal Marsh Streams)
Consider “vegetated buffer” and “wooded buffer” separately for left bank (LB) and right bank (RB) starting at the top of bank out
to the first break.
Vegetated Wooded
LB RB LB RB
A A A A ≥ 100 feet wide or extends to the edge of the watershed
B B B B From 50 to < 100 feet wide
C C C C From 30 to < 50 feet wide
D D D D From 10 to < 30 feet wide
E E E E < 10 feet wide or no trees
20. Buffer Structure – streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 (“Vegetated” Buffer Width).
LB RB
A A Mature forest
B B Non-mature woody vegetation or modified vegetation structure
C C Herbaceous vegetation with or without a strip of trees < 10 feet wide
D D Maintained shrubs
E E Little or no vegetation
21. Buffer Stressors – streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB). Indicate if listed stressor abuts stream (Abuts), does not abut but
is within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If none of the following stressors occurs on either bank, check here and skip to Metric 22:
Abuts < 30 feet 30-50 feet
LB RB LB RB LB RB
A A A A A A Row crops
B B B B B B Maintained turf
C C C C C C Pasture (no livestock)/commercial horticulture
D D D D D D Pasture (active livestock use)
22. Stem Density – streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 (“Wooded” Buffer Width).
LB RB
A A Medium to high stem density
B B Low stem density
C C No wooded riparian buffer or predominantly herbaceous species or bare ground
23. Continuity of Vegetated Buffer – streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10 feet wide.
LB RB
A A The total length of buffer breaks is < 25 percent.
B B The total length of buffer breaks is between 25 and 50 percent.
C C The total length of buffer breaks is > 50 percent.
24. Vegetative Composition – streamside area metric (skip for Tidal Marsh Streams)
Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contribute s to
assessment reach habitat.
LB RB
A A Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native species,
with non-native invasive species absent or sparse.
B B Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear -cutting or clearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
C C Vegetation is severely disturbed in terms of species diversity or proport ions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non-characteristic species or communities inappropriately composed of a single species or no vegetation.
25. Conductivity – assessment reach metric (skip for all Coastal Plain streams)
25a. Yes No Was conductivity measurement recorded?
If No, select one of the following reasons. No Water Other:
25b. Check the box corresponding to the conductivity measurement (units of microsiemens per centimeter).
A < 46 B 46 to < 67 C 67 to < 79 D 79 to < 230 E ≥ 230

Notes/Sketch:
Assessment was done on 100ft upstream as downstream banks are dangerous plus large scour hole exists

Draft NC SAM Stream Rating Sheet
Accompanies User Manual Version 2.1

Stream Site Name Chandworth-Upstream Date of Assessment 6/20/2018
Stream Category Pb1 Assessor Name/Organization HMS

Notes of Field Assessment Form (Y/N) YES
Presence of regulatory considerations (Y/N) NO
Additional stream information/supplementary measurements included (Y/N) NO
NC SAM feature type (perennial, intermittent, Tidal Marsh Stream) Intermittent

Function Class Rating Summary
USACE/
All Streams
NCDWR
Intermittent
(1) Hydrology

LOW LOW
(2) Baseflow

MEDIUM MEDIUM
(2) Flood Flow

LOW LOW

(3) Streamside Area Attenuation LOW LOW
(4) Floodplain Access LOW LOW
(4) Wooded Riparian Buffer LOW LOW

(4) Microtopography NA NA
(3) Stream Stability

LOW LOW

(4) Channel Stability HIGH HIGH

(4) Sediment Transport LOW LOW
(4) Stream Geomorphology LOW LOW
(2) Stream/Intertidal Zone Interaction NA NA
(2) Longitudinal Tidal Flow NA NA
(2) Tidal Marsh Stream Stability NA NA
(3) Tidal Marsh Channel Stability NA NA
(3) Tidal Marsh Stream Geomorphology NA NA
(1) Water Quality LOW LOW
(2) Baseflow

MEDIUM MEDIUM
(2) Streamside Area Vegetation

LOW LOW
(3) Upland Pollutant Filtration LOW LOW
(3) Thermoregulation MEDIUM MEDIUM
(2) Indicators of Stressors YES YES
(2) Aquatic Life Tolerance MEDIUM NA
(2) Intertidal Zone Filtration NA NA
(1) Habitat LOW LOW
(2) In-stream Habitat

LOW LOW
(3) Baseflow

MEDIUM MEDIUM
(3) Substrate

LOW LOW
(3) Stream Stability

MEDIUM MEDIUM
(3) In-stream Habitat

LOW LOW
(2) Stream-side Habitat

LOW LOW
(3) Stream-side Habitat

LOW LOW
(3) Thermoregulation LOW LOW
(2) Tidal Marsh In-stream Habitat

NA NA
(3) Flow Restriction

NA NA
(3) Tidal Marsh Stream Stability NA NA
(4) Tidal Marsh Channel Stability NA NA
(4) Tidal Marsh Stream Geomorphology NA NA
(3) Tidal Marsh In-stream Habitat

NA NA
(2) Intertidal Zone

NA NA
Overall LOW LOW

USACE AID #:NCDWR #:
PROJECT / SITE INFORMATION:
1. Project name (if any):2. Date of evaluation:
3. Applicant/owner name:
5. County:6. Nearest named water body
7. River Basin: on USGS 7.5-minute quad:
8. Site coordinates (decimal degrees, at lower end of assessment reach):
STREAM INFORMATION: (depth and width can be approximations)
9. Site number (show on attached map):10. Length of assessment reach evaluated (feet):
11. Channel depth from bed (in riffle, if present) to top of bank (feet):Unable to assess channel depth.
12. Channel width at top of bank (feet):13. Is assessment reach a swamp stream?Yes No
14. Feature type:Perennial flow Intermittent flow Tidal Marsh Stream
STREAM RATING INFORMATION:
15. NC SAM Zone:Mountains (M)Piedmont (P)Inner Coastal Plain (I)Outer Coastal Plain (O)
16. Estimated geomorphic
valley shape (skip for a b
Tidal Marsh Stream):(more sinuous stream, flatter valley slope)(less sinuous stream, steeper valley slope)
17. Watershed size: (skip Size 1 (< 0.1 mi2)Size 2 (0.1 to < 0.5 mi2)Size 3 (0.5 to < 5 mi2)Size 4 (≥ 5 mi2)
for Tidal Marsh Stream)
ADDITIONAL INFORMATION:
18. Were regulatory considerations evaluated?Yes No If Yes, check all that appy to the assessment area.
Section 10 water Classified Trout Waters Water Supply Watershed (I II III IV V)
Essential Fish Habitat Primary Nursery Area High Quality Waters/Outstanding Resource Waters
Publicly owned property NCDWR riparian buffer rule in effect Nutrient Sensitive Waters
Anadromous fish 303(d) List CAMA Area of Environmental Concern (AEC)
Documented presence of a federal and/or state listed protected species within the assessment area.
List species:
Designated Critical Habitat (list species):
19. Are additional stream information/supplementary measurements included in "Notes/Sketch" section or attached?Yes No
1.Channel Water – assessment reach metric (skip for Size 1 streams and Tidal Marsh Streams)
A Water throughout assessment reach.
B No flow, water in pools only.
C No water in assessment reach.
2.Evidence of Flow Restriction – assessment reach metric
A At least 10% of assessment reach in-stream habitat or riffle-pool sequence is adversely affected by a flow restriction or fill to the
point of obstructing flow or a channel choked with aquatic macrophytes or ponded water or impounded on flood or ebb within
the assessment reach (examples: undersized or perched culverts, causeways that constrict the channel, tidal gates).
B Not A
3.Feature Pattern – assessment reach metric
A A majority of the assessment reach has altered pattern (examples: straightening, modification above or below culvert).
B Not A.
4.Feature Longitudinal Profile – assessment reach metric
A Majority of assessment reach has a substantially altered stream profile (examples: channel down-cutting, existing damming,
over widening, active aggradation, dredging, and excavation where appropriate channel profile has not reformed from any of
these disturbances).
B Not A
5.Signs of Active Instability – assessment reach metric
Consider only current instability, not past events from which the stream has currently recovered. Examples of instability include
active bank failure, active channel down-cutting (head-cut), active widening, and artificial hardening (such as concrete, gabion, rip-rap).
A < 10% of channel unstable
B 10 to 25% of channel unstable
C > 25% of channel unstable
2.5
11
NC SAM FIELD ASSESSMENT FORM
Accompanies User Manual Version 2.1
INSTRUCTIONS:Attach a sketch of the assessment area and photographs.Attach a copy of the USGS 7.5-minute topographic
quadrangle,and circle the location of the stream reach under evaluation.If multiple stream reaches will be evaluated on the same
property,identify and number all reaches on the attached map,and include a separate form for each reach.See the NC SAM User
Manual for detailed descriptions and explanations of requested information. Record in the "Notes/Sketch" section if any supplementary
NOTE EVIDENCE OF STRESSORS AFFECTING THE ASSESSMENT AREA (do not need to be within the assessment area).
measurements were performed. See the NC SAM User Manual for examples of additional measurements that may be relevant.
Chandworth SDIP / Stream Enhancement 7/3/2019
35.134079°N 80.848907°W
Stream on Map ~100
Charlotte Storm Water Services 4. Assessor name/organization:D. Homans / S&ME
Mecklenburg
Lower Catawba Little Sugar Creek
OUTFALL CHANNEL
6.Streamside Area Interaction – streamside area metric
Consider for the Left Bank (LB) and the Right Bank (RB).
LB RB
A A Little or no evidence of conditions that adversely affect reference interaction
B B Moderate evidence of conditions (examples: berms, levees, down-cutting, aggradation, dredging) that adversely affect
reference interaction (examples: limited streamside area access, disruption of flood flows through streamside area,
leaky or intermittent bulkheads, causeways with floodplain constriction, minor ditching [including mosquito ditching])
C C Extensive evidence of conditions that adversely affect reference interaction (little to no floodplain/intertidal zone access
[examples: causeways with floodplain and channel constriction, bulkheads, retaining walls, fill, stream incision,
disruption of flood flows through streamside area] or too much floodplain/intertidal zone access [examples:
impoundments, intensive mosquito ditching]) or floodplain/intertidal zone unnaturally absent or assessment reach is a
man-made feature on an interstream divide
7.Water Quality Stressors – assessment reach/intertidal zone metric
Check all that apply.
A Discolored water in stream or intertidal zone (milky white, blue, unnatural water discoloration, oil sheen, stream foam)
B Excessive sedimentation (burying of stream features or intertidal zone)
C Noticeable evidence of pollutant discharges entering the assessment reach and causing a water quality problem
D Odor (not including natural sulfide odors)
E Current published or collected data indicating degraded water quality in the assessment reach. Cite source in the "Notes/Sketch"
section.
F Livestock with access to stream or intertidal zone
G Excessive algae in stream or intertidal zone
H Degraded marsh vegetation in the intertidal zone (removal, burning, regular mowing, destruction, etc.)
I Other:(explain in "Notes/Sketch" section)
J Little to no stressors
8.Recent Weather – watershed metric
For Size 1 or 2 streams, D1 drought or higher is considered a drought; for Size 3 or 4 streams, D2 drought or higher is considered a
drought.
A Drought conditions and no rainfall or rainfall not exceeding 1 inch within the last 48 hours
B Drought conditions and rainfall exceeding 1 inch within the last 48 hours
C No drought conditions
9 Large or Dangerous Stream – assessment reach metric
Yes No Is stream is too large or dangerous to assess? If Yes, skip to Metric 13 (Streamside Area Ground Surface Condition).
10.Natural In-stream Habitat Types – assessment reach metric
10a.Yes No Degraded in-stream habitat over majority of the assessment reach (examples of stressors include excessive
sedimentation, mining, excavation, in-stream hardening [for example, rip-rap], recent dredging, and snagging)
(evaluate for size 4 Coastal Plain streams only, then skip to Metric 12)
10b.Check all that occur (occurs if > 5% coverage of assessment reach) (skip for Size 4 Coastal Plain streams)
A Multiple aquatic macrophytes and aquatic mosses F 5% oysters or other natural hard bottoms
(include liverworts, lichens, and algal mats)G Submerged aquatic vegetation
B Multiple sticks and/or leaf packs and/or emergent H Low-tide refugia (pools)
vegetation I Sand bottom
C Multiple snags and logs (including lap trees)J 5% vertical bank along the marsh
D 5% undercut banks and/or root mats and/or roots K Little or no habitat
in banks extend to the normal wetted perimeter
E Little or no habitat
11.Bedform and Substrate – assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
11a.Yes No Is assessment reach in a natural sand-bed stream? (skip for Coastal Plain streams)
11b.Bedform evaluated. Check the appropriate box(es).
A Riffle-run section (evaluate 11c)
B Pool-glide section (evaluate 11d)
C Natural bedform absent (skip to Metric 12, Aquatic Life)
11c.In riffles sections, check all that occur below the normal wetted perimeter of the assessment reach – whether or not submerged.
Check at least one box in each row (skip for Size 4 Coastal Plain Streams and Tidal Marsh Streams). Not Present (NP) =
absent, Rare (R) = present but ≤ 10%, Common (C) = > 10-40%, Abundant (A) = > 40-70%, Predominant (P) = > 70%. Cumulative
percentages should not exceed 100% for each assessment reach.
NP R C A P
Bedrock/saprolite
Boulder (256 – 4096 mm)
Cobble (64 – 256 mm)
Gravel (2 – 64 mm)
Sand (.062 – 2 mm)
Silt/clay (< 0.062 mm)
Detritus
Artificial (rip-rap, concrete, etc.)
11d.Yes No Are pools filled with sediment? (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
Urban Residential Conditions (Lawn Chemicals)
*********************************REMAINING QUESTIONS ARE NOT APPLICABLE FOR TIDAL MARSH STREAMS****************************Check for TidalMarsh Streamsonly
12.Aquatic Life – assessment reach metric (skip for Size 4 Coastal Plain streams and Tidal Marsh Streams)
12a.Yes No Was an in-stream aquatic life assessment performed as described in the User Manual?
If No, select one of the following reasons and skip to Metric 13. No Water Other:
12b.Yes No Are aquatic organisms present in the assessment reach (look in riffles, pools, then snags)? If Yes, check
all that apply. If No, skip to Metric 13.
1 >1 Numbers over columns refer to “individuals” for size 1 and 2 streams and “taxa” for size 3 and 4 streams.
Adult frogs
Aquatic reptiles
Aquatic macrophytes and aquatic mosses (include liverworts, lichens, and algal mats)
Beetles (including water pennies)
Caddisfly larvae (Trichoptera [T])
Asian clam (Corbicula )
Crustacean (isopod/amphipod/crayfish/shrimp)
Damselfly and dragonfly larvae
Dipterans (true flies)
Mayfly larvae (Ephemeroptera [E])
Megaloptera (alderfly, fishfly, dobsonfly larvae)
Midges/mosquito larvae
Mosquito fish (Gambusia ) or mud minnows (Umbra pygmaea)
Mussels/Clams (not Corbicula )
Other fish
Salamanders/tadpoles
Snails
Stonefly larvae (Plecoptera [P])
Tipulid larvae
Worms/leeches
13.Streamside Area Ground Surface Condition – streamside area metric (skip for Tidal Marsh Streams and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB). Consider storage capacity with regard to both overbank flow and
upland runoff.
LB RB
A A Little or no alteration to water storage capacity over a majority of the streamside area
B B Moderate alteration to water storage capacity over a majority of the streamside area
C C Severe alteration to water storage capacity over a majority of the streamside area (examples include: ditches, fill,
soil, compaction, livestock disturbance, buildings, man-made levees, drainage pipes)
14.Streamside Area Water Storage – streamside area metric (skip for Size 1 streams, Tidal Marsh Streams, and B valley types)
Consider for the Left Bank (LB) and the Right Bank (RB) of the streamside area.
LB RB
A A Majority of streamside area with depressions able to pond water ≥ 6 inches deep
B B Majority of streamside area with depressions able to pond water 3 to 6 inches deep
C C Majority of streamside area with depressions able to pond water < 3 inches deep
15.Wetland Presence – streamside area metric (skip for Tidal Marsh Streams)
Consider for the Left Bank (LB) and the Right Bank (RB). Do not consider wetlands outside of the streamside area or within the
normal wetted perimeter of assessment reach.
LB RB
Y Y Are wetlands present in the streamside area?
N N
16.Baseflow Contributors – assessment reach metric (skip for size 4 streams and Tidal Marsh Streams)
Check all contributors within the assessment reach or within view of and draining to the assessment reach.
A Streams and/or springs (jurisdictional discharges)
B Ponds (include wet detention basins; do not include sediment basins or dry detention basins)
C Obstruction that passes some flow during low-flow periods within assessment area (beaver dam, bottom-release dam)
D Evidence of bank seepage or sweating (iron oxidizing bacteria in water indicates seepage)
E Stream bed or bank soil reduced (dig through deposited sediment if present)
F None of the above
17.Baseflow Detractors – assessment area metric (skip for Tidal Marsh Streams)
Check all that apply.
A Evidence of substantial water withdrawals from the assessment reach (includes areas excavated for pump installation)
B Obstruction not passing flow during low flow periods affecting the assessment reach (ex: watertight dam, sediment deposit)
C Urban stream (≥ 24% impervious surface for watershed)
D Evidence that the stream-side area has been modified resulting in accelerated drainage into the assessment reach
E Assessment reach relocated to valley edge
F None of the above
18.Shading – assessment reach metric (skip for Tidal Marsh Streams)
Consider aspect. Consider “leaf-on” condition.
A Stream shading is appropriate for stream category (may include gaps associated with natural processes)
B Degraded (example: scattered trees)
C Stream shading is gone or largely absent
19.Buffer Width – streamside area metric (skip for Tidal Marsh Streams)
Consider “vegetated buffer” and “wooded buffer” separately for left bank (LB) and right bank (RB) starting at the top
of bank out to the first break.
Vegetated Wooded
LB RB LB RB
A A A A ≥ 100-feet wide or extends to the edge of the watershed
B B B B From 50 to < 100-feet wide
C C C C From 30 to < 50-feet wide
D D D D From 10 to < 30-feet wide
E E E E < 10-feet wide or no trees
20.Buffer Structure – streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Vegetated" Buffer Width).
LB RB
A A Mature forest
B B Non-mature woody vegetation or modified vegetation structure
C C Herbaceous vegetation with or without a strip of trees < 10 feet wide
D D Maintained shrubs
E E Little or no vegetation
21.Buffer Stressors – streamside area metric (skip for Tidal Marsh Streams)
Check all appropriate boxes for left bank (LB) and right bank (RB). Indicate if listed stressor abuts stream (Abuts), does not abut but
is within 30 feet of stream (< 30 feet), or is between 30 to 50 feet of stream (30-50 feet).
If none of the following stressors occurs on either bank, check here and skip to Metric 22:
Abuts < 30 feet 30-50 feet
LB RB LB RB LB RB
A A A A A A Row crops
B B B B B B Maintained turf
C C C C C C Pasture (no livestock)/commercial horticulture
D D D D D D Pasture (active livestock use)
22.Stem Density – streamside area metric (skip for Tidal Marsh Streams)
Consider for left bank (LB) and right bank (RB) for Metric 19 ("Wooded" Buffer Width).
LB RB
A A Medium to high stem density
B B Low stem density
C C No wooded riparian buffer or predominantly herbaceous species or bare ground
23.Continuity of Vegetated Buffer – streamside area metric (skip for Tidal Marsh Streams)
Consider whether vegetated buffer is continuous along stream (parallel). Breaks are areas lacking vegetation > 10-feet wide.
LB RB
A A The total length of buffer breaks is < 25 percent.
B B The total length of buffer breaks is between 25 and 50 percent.
C C The total length of buffer breaks is > 50 percent.
24.Vegetative Composition – First 100 feet of streamside area metric (skip for Tidal Marsh Streams)
Evaluate the dominant vegetation within 100 feet of each bank or to the edge of the watershed (whichever comes first) as it contributes
to assessment reach habitat.
LB RB
A A Vegetation is close to undisturbed in species present and their proportions. Lower strata composed of native
species, with non-native invasive species absent or sparse.
B B Vegetation indicates disturbance in terms of species diversity or proportions, but is still largely composed of native
species. This may include communities of weedy native species that develop after clear-cutting or clearing or
communities with non-native invasive species present, but not dominant, over a large portion of the expected strata or
communities missing understory but retaining canopy trees.
C C Vegetation is severely disturbed in terms of species diversity or proportions. Mature canopy is absent or communities
with non-native invasive species dominant over a large portion of expected strata or communities composed of planted
stands of non-characteristic species or communities inappropriately composed of a single species or no vegetation.
25.Conductivity – assessment reach metric (skip for all Coastal Plain streams)
25a.Yes No Was a conductivity measurement recorded?
If No, select one of the following reasons. No Water Other:
25b.Check the box corresponding to the conductivity measurement (units of microsiemens per centimeter).
A <46 B 46 to < 67 C 67 to < 79 D 79 to < 230 E ≥ 230
Notes/Sketch:
See Map / Site Photographs. Sewage odor was evident, some oil sheen; high conductivity & lack of macrobenthos = poor water quality.
Notes of Field Assessment Form (Y/N)
Presence of regulatory considerations (Y/N)
Additional stream information/supplementary measurements included (Y/N)
NC SAM feature type (perennial, intermittent, Tidal Marsh Stream)
(4) Floodplain Access
(4) Wooded Riparian Buffer
(4) Microtopography
(3) Stream Stability
(4) Channel Stability
(4) Sediment Transport
(4) Stream Geomorphology
(2) Stream/Intertidal Zone Interaction
(2) Longitudinal Tidal Flow
(2) Tidal Marsh Stream Stability
(3) Tidal Marsh Stream Geomorphology
(1) Water Quality
(2) Baseflow
(2) Streamside Area Vegetation
(3) Upland Pollutant Filtration
(3) Thermoregulation
(2) Indicators of Stressors
(2) Aquatic Life Tolerance
(2) Intertidal Zone Filtration
(1) Habitat
(2) In-stream Habitat
(3) Baseflow
(3) Substrate
(3) Stream Stability
(3) In-stream Habitat
(2) Stream-side Habitat
(3) Stream-side Habitat
(3) Thermoregulation
(2) Tidal Marsh In-stream Habitat
(3) Flow Restriction
(3) Tidal Marsh Stream Stability
(4) Tidal Marsh Stream Geomorphology
(3) Tidal Marsh In-stream Habitat
(2) Intertidal Zone Habitat
Overall
NC SAM Stream Rating Sheet
Accompanies User Manual Version 2.1
MEDIUM
HIGH
USACE/
All Streams
NCDWR
Intermittent
NA
NA
(2) Flood Flow
D. Homans / S&ME
7/3/2019
YES
NO
YES
Perennial
(2) Baseflow
Stream Category Assessor Name/Organization
HIGH
Pa2
Stream Site Name Chandworth SDIP / Stream Enhancement Date of Evaluation
HIGH
(4) Tidal Marsh Channel Stability
HIGH
MEDIUM
NA
NA
MEDIUM
NA
HIGH
(3) Tidal Marsh Channel Stability
(3) Streamside Area Attenuation
Function Class Rating Summary
(1) Hydrology
NA
MEDIUM
HIGH
HIGH
HIGH
NA
YES
HIGH
NA
NA
NA
NA
HIGH
HIGH
HIGH
HIGH
HIGH
MEDIUM
HIGH
MEDIUM
HIGH
NA
NA
HIGH
LOW
HIGH
HIGH
HIGH