20140004 Ver 1_More Info Received_20140123

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat? ❑ yes ❑ No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts?
D Yes ❑ No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
6. Essential Fish Habitat (Corps Requirement)
6a, Wili this project occur in or near an area designated as essential fish habitat?
❑ Yes
fib. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that :the tate, federal or tribal governments have designated as having histr cultural preservation status (e.g., National Historic Trust designatiproperties significant in
North Carolina history and archaeology)?
❑Yes ❑ No
9 y)
7b.. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement) '
8a. Wiil this project occur in a FEMA - designated 900- yearfloodplain?
❑ Yes � No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Applicant /Agent's Printed Name ApplicantlAge is Signature
(Agent's signature is valid only if an authorization Date
letter from the aoolirant � n— %,iA,.a N
dn w teA� M oof r Q u
Page 10 of 10 JAN 2 3 2014
wafer t?aeltty Regional Operation's
Asheville 9 Office
Re iaraalOffice

i
F. Supplementary Information
1, Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public .(federallstatellocal) funds or the yes l -t o
use of public (federal /state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State 1 ❑Yes ❑ No
(North Carolina) Environmental Policy Act (NEPAISEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (if so, attach a copy of the NEPA or SEPA final approval Yes R No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of IDWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2M .1300), DWQ Surface Water or Wetland Standards, es ❑ No
or Riparian Buffer Rules (15A NCAC 26 .0200)?
2b. Is this an after - the -fact permit application? ❑ No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
V -ms's toa_S f1 tM1
0 -bT o-
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in []Yeso
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project, or avails capacity of the subject facility.
Page 9of10
PCN Form— Version 1.4 January 2009