20230207 Ver 1_PCN Form_20230203

_ 9
io
NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. "Click to enter.] Date received: [Click to enter.]
DWR project no. [Click enter.] Date received: 'Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.528914
Longitude (DD.DDDDDD): 80.954030
Form Version 4.3, April 20, 2022
Pre -Construction Notification (PCN) Form
(Ver. 4.2, January 31, 2022))
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk * are required. The form is not considered complete until all
mandatory questions are answered.
The PCN help document may be found at this link:
https://edocs.deg.nc.gov/WaterResources/DocView aspx?dbid=0&id=2196924&cr=1
Please ensure you have submitted a pre -filing meeting request at least 30 days prior to submitting this
form, as DWR will not be able to accept your application without documentation of this important first step.
The Division has developed a Pre -filing Meeting Request email address 4.01 PreFile(a_ncdenr.gov to accept
the federally required pre -filing meeting request and provide confirmation receipt of submittal . This receipt
or similar documentation will satisfy 40 C.F.R. Section 121.4(a) which states "At least 30 days prior to
submitting a certification request, the project proponent shall request a pre -filing meeting with the certifying
agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all certification requests must
include documentation that a pre -filing meeting request was submitted to the certifying authority at least 30
days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
Date of Pre -filing Meeting Request (MM/DD/YYYY) ''`: 1/4/2023
Page 1 of 21 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located:
Iredell Additional (if needed).
Is this a NCDMS project? '
(Click yes only if NCDMS is the applicant or co-
❑ Yes © No
applicant)
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes M No
or airport project)
Is this a NCDOT project?
❑ Yes © No
If yes, NCDOT TIP or state project number:
Click to enter
If yes, NCDOT WBS number: '
Click to enter.
© Section 404 Permit (wetlands, streams, waters,
1 a. Type(s) of approval sought from the Corps:`
Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
❑ Yes ® No
Please provide the date of the previous submission. *
Click to enter a date.
0 Nationwide Permit (NWP)
1 b. What type(s) of permit(s) do you wish to seek
authorization? *
❑ Regional General Permit RGP
g ( )
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as attachments and
submitted with this form.
1c. Has the NWP or GP number been verified by the Corps?*
❑ Yes © No
NWP number(s) (list all numbers ):
3
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
❑ Yes © No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act
Click -UO enter text.
1d. Type(s) of approval sought from DWR (check all that apply):
© 401 Water Quality Certification — Regular
❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit
❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
Is this a courtesy copy notification
❑ Yes © No
1e. Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: *
❑ Yes ❑x No
For the record only for Corps Permit: *
❑ Yes © No
1f. Is this an after -the -fact permit/certification application?
❑ Yes ® No
Page 2 of 21 PCN Form Version 4.3- April 20, 2022

1g. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
El Yes ©No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h. Is the project located in any of NC's twenty coastal counties? *
❑ Yes ❑x No
1 i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)? *
❑ Yes © No ❑ Unknown
1j. Is the project located in a designated trout watershed? ''`
❑ Yes ❑x No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 21 PCN Form Version 4.3- April 20, 2022

B. Applicant Information
1a.
Who is the primary contact? *
Janice Estep
1 b.
Primary Contact Email: *
[e-mail]
1 c.
Primary Contact Phone: * (###)###
704-660-5111
1d.
Who is applying for the permit/certification? - (check
all that apply)
❑ Owner Z Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?*
Z Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed: '
KPL Properties, LLC
2b.
Deed Book and Page No.:
2908/1118
2c.
Contact Person (for corporations):
Kyle Leciejewski for KPL Properties, LLC
2d.
Address *
Street Address:
215 Falmouth Rd.
Address line 2:
Click to enter.
City:
Mooresville
State/ Province/ Region:
NC
Postal/ Zip Code:
28117
Country:
us
2e.
Telephone Number: " (###)####
440-479-3502
2f.
Fax Number: (###)###-
Click to enter.
2g.
Email Address:
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name: *
Janice Estep for KPL Properties, LLC
3b.
Business Name (if applicable):
CBC Stone & Recycling, LLC
3c.
Address:
Street Address:
638 Oakridge Farm Hwy.
Address line 2:
Click tQ enter.
City:
Mooresville
State/ Province/ Region:
NC
Postal/ Zip Code:
28115
Country
us
3d.
Telephone Number: (##I#)###-##t##
704-660-5111
3e
Fax Number: (###)###-####
Mick to enter.
3f.
Email Address: *
[e-mail]
Page 4 of 21 PCN Form Version 4.3- April 20, 2022

4. Agent/ Consultant (if applicable)
4a. Name: '
Janice Estep
4b. Business Name:
CBC Stone & Recycling, LLC
4c. Address: x
Street Address:
638 Oakridge Farm Hwy.
Address line 2:
Click to enter.
City:
Mooresville
State/ Province/ Region:
NC
Postal/ Zip Code:
28115
Country:
us
4d. Telephone Number: * (###)###-####
704-660-5111
4e Fax Number: (###)##/#-####
Click to enter.
4f. Email Address: *
[e-mail]
Agent Authorization Letter:*
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www. saw. usace.army. mil/Missions/Regu latory-Permit-Program/Permits/2017-Nationwide-Permits/Pre
construction -Notification/
Page 5 of 21 PCN Form Version 4.3- April 20, 2022

C. Project Information and Prior Project History
1. Project Information
1a. Name of project: *
KPL Properties Shoreline
1 b. Subdivision name (if appropriate):
Stonemarker Pointe
1 c. Nearest municipality/town: *
Mooresville
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
4615836191
2b.
Property size (in acres):
1.64 acres
2c.
Project Address:
Street Address:
121 Stone Point Court
Address line 2:
Click to enter_
City:
Mooresville
State/ Province/ Region:
NC
Postal/ Zip Code:
28117
Country:
US
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.528914
Longitude (-DD.DDDDDD): *-80.954030
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Lake Norman
3b. Water Resources Classification of nearest receiving
WS-IV,B;CA
water: *
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcgis.com/apes/webappviewer/index htmI?id=6e125ad7628f494694e259c8Odd64265
3c. In what river basin(s) is your project located? }
Choose one
Catawba
3d. Please provide the 12-digit HUC in which the project is
030501011202
located: *
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Pubiiclnformation/index html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 21 PCN Form Version 4.3- April 20, 2022

4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application: *
Undeveloped lot in residential area
4b. Have Corps permits or DWR certifications been obtained for this
project (including all prior phases) in the past? *
❑ Yes ❑ No ❑x Unknown
If yes, please give the DWR Certification number and/or Corps
[Click to eater.]
Action ID (ex. SAW-0000-00000):
;Click to enter.]
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete? *
❑ Yes © No
If yes, describe the completed work.
Cliol; to inter text.
4c. List of other certifications or approvals/denials received from other federal, state or local agencies for work
described in this application not related to the 404 or 401.
Click to enter text.
4d. Attach an 8'/ x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'/z x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f. List the total estimated acreage of all existing wetlands on the
property:
Click to enter acres
4g. List the total estimated linear feet of all existing streams (intermittent
and perennial) on the property:
0 linear feet
4g1. List the total estimated acreage of all existing open waters on the
property:
0.19 acres
4h. Explain the purpose of the proposed project:
Repair and maintenance of existing shoreline stabilization. Existing bulkhead is failing. Control and prevention of
shoreline erosion
4i. Describe the overall project in detail, including the type of equipment to be used:
Remove top 4' of existing 8' high bulkhead. Repair erosion issues where bulkhead is failing and replace top 4'
with a boulder wall. On the bottom 4' of bulkhead, install boulder rip rap at a 2:1 slopeextending upward 4' to
base of new boulder wall. Existing damaged block steps to be replace with stone stair treads. Dump truck will be
used to deliver materials and materials will be stored out side of buffer area. Skis steer will be used to transport
material to shoreline area and project will be done using a standard excavator.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters?
❑ Yes ❑x No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
`v=sck to enter text.
Page 7 of 21 PCN Form Version 4.3-April 20, 2022

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on
the property or in
proposed impact areas?
❑ Yes © No ❑ Unknown
Comments:
Click to enter text.
5b.
If the Corps made a jurisdictional determination,
❑x Preliminary ❑ Approved ❑ Emailed concurrence
what type of determination was made? *
❑ Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW-2023-00042
Name (if known): Click to enter.
5c.
If 5a is yes, who delineated the jurisdictional
areas?
Agency/Consultant Company: Click to enter.
Other: Click to enter.
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
1 /4/2023
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑Yes © No
6b. If yes, explain.
Click to enter.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to
authorize any part of the proposed project or related activity? This includes other separate and distant crossings
for linear projects that require Department of the Army authorization but don't require pre -construction
notification.
Click to enter.
7. Addresses of adjoining property owners, lessees, etc. whose property adjoins the waterbody (if more than can be
entered here, please attach a supplemental list)
Click to enter.
8. Scheduling of activity:
Click to enter.
Page 8 of 21 PCN Form Version 4.3- April 20, 2022

D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project
(check all that apply):
❑ Wetlands
® Buffers
❑ Pond Construction
❑ Streams - tributaries
0 Open Waters
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #*
2al.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Type*
2d.
Wetland Name*
2e.
Forested
?*
2f.
Jurisdiction
Type-
2g.
Impact Area
(ac)*
W1
Choose one
Temp/ Perm
Choose one
Click to enter
YIN
Choose one
Click to enter
W2
Choose one
Temp/ Perm
Choose one
Click to enter
YIN
Choose one
Click to enter
W3
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W4
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W5
Choose one
Temp/ Perm
Choose one
Click to enter
YIN
Choose one
Click to enter
W6
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W7
Choose one
Tempi Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W9
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W10
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W12
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W13
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W14
Choose one
Temp/ Perm
Choose one
Click to enter
YIN
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
2gl. Total temporary wetland impacts
Click to enter. ac
2g2. Total permanent wetland impacts
Click to enter. ac
2g3. Total wetland impacts
Click to enter. ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to enter text.
2i. Comments:
Click to enter text.
Page 9 of 21 PCN Form Version 4.3- April 20, 2022

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #*
3a
Impact
Reason*
3b.
Impact
Duration*
3c.
Impact Type*
3d.
Stream Name*
3e.
Stream
Type*
3f.
Jurisdiction
Type*
3g.
Stream Width
(avg ft) *
3h.
Impact length
(linear ft) *
S1
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S2
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Click to enter
Temp; Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/int
Choose one
Click to enter
Click to enter
S6
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/int
Choose one
Click to enter
Click to enter
S7
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Click to enter
Temp/ Perm
Choose one
Click to enter
Perlint
Choose one
Click to enter
Click to enter
S9
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Perlint
Choose one
Click to enter
Click to enter
S14
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S17
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Tempi Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3il. Total jurisdictional ditch
impact:
Click to enter. linear ft
M. Total permanent stream
impacts:
C lick to enter linear ft
M. Total temporary stream
impacts:
Click to enter. linear ft
34. Total stream and ditch
impacts:
Click to enter. linear ft
3j. Comments:
Click to enter.
Page 10 of 21 PCN Form Version 4.3- April 20, 2022

4.
Open Water Impacts
If there are proposed impacts to lakes,
ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or
any other
open water of the U.S., individually list all open water impacts in the table below.
4a.
4a1.
4b,
4c.
4d.
4e.
4f.
Site #*
Impact Reason
Impact
Waterbody Name*
Activity Type*
Waterbody
Impact area
Duration*
Type*
(ac)*
01
Erosion Control and
Permanent
Lake Norman
Bank
Lake
0.19
Prevention
Stabilization/ Fill
(Incl. Riprap)
02
Click to enter.
Temp/ Perm
Click to eater.
Choose one
Choose one
Click to enter.
03
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to tinter.
Choose one
Choose one
Click to enter.
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
0.19 ac
4g. Total open water impacts
0.19 ac
4h.
Comments:
Repair failing bulkhead on shoreline to control erosion. Length of shoreline is approx. 1000 If and bulkhead is
approx. 8' high.
5.
Pond or Lake Construction
If pond or lake construction is proposed, complete the table
below. (*This does NOT include offline stormwater
management ponds.)
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts
(ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter,
enter,
enter.
enter.
enter..
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter. I
enter.
enter.
enter
enter.
enter.
5g.
Comments:
Click to enter.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i.
Expected pond surface area (acres):
Click to enter.
5j. Size of pond watershed (acres):
Click to enter.
5k. Method of construction:
Click to enter.
Page 11 of 21 PCN Form Version 4.3- April 20, 2022

Page 12 of 21 PCN Form Version 4.3- April 20, 2022

6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
* (Check all that apply.)
El Neuse El Tar -Pamlico ® Catawba
El Jordan El Goose Creek El Randleman
❑ Other: Click to enter.
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
61
Bank Stabilization
Temporary
Lake Norman
No
300
200
B2
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perin
Click to enter.
YIN
Click to enter.
Click to enter.
B11
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B14
Choose one
Temp/ Penn
Click to enter.
YIN
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B1 s
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
YIN
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: 300 sq ft
Zone 2: 200 sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: 300 sq ft
Zone 2: 200 sq ft
6i. Comments:
10' x 50' contruction corridor through buffer for access to shoreline
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 13 of 21 PCN Form Version 4.3- April 20, 2022

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
Project will be shoreline stabilization only. Contsruction will be be within the same footprint as current
stabilization
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
Project will be done using a 1 O' x 50' temporary access corridor. Materials need for project will be stored outside
of buffer area. Any areas disturbed by work will be restored to original condition.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? ❑ DWR ❑ Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ElMitigation Bank
project? - (check all that apply) El In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank (Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Click to enter.
4. Complete if Using an In Lieu Fee Program
4a. Attach approval letter from in lieu fee program.
4b. Stream mitigation requested:
Click to enter. linear feet
4c. If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RI BITS website: (Please use the filter and select Wilmington district)
https://ribits. usace.army mil/ribits apex/f?p=107:27:2734709611497::N0.RP: P27 BUTTON KEY:O
4d. Buffer mitigation requested (DWR only):
Click to enter. square feet
4e. Riparian wetland mitigation requested:
Click to enter. acres
4f. Non -riparian wetland mitigation requested:
Click to enter. acres
4g. Coastal (tidal) wetland mitigation requested:
Click to enter. acres
4h. Comments:
Click to enter.
Page 14 of 21 PCN Form Version 4.3- April 20, 2022

5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigation credits generated.
Click to enter
5b. Attach mitigation plan/documentation.
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a.
Will the project result in an impact within a protected riparian buffer
that requires buffer mitigation?
❑ Yes ® No
If yes, please complete this entire section — please contact DWR for more information.
6b.
If yes, identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required in the table below.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone
1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone
2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
NC Division of Mitigation Services proposed?
❑ Yes El No
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i.
Comments:
Click to enter.
Page 15 of 21 PCN Form Version 4.3- April 20, 2022

' F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
identified within one of the NC Riparian Buffer Protection Rules?
❑ Yes © No
1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse/dispersed flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https:Hdeg.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ Other SCM that removes minimum 30% nitrogen
❑x Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here.
Attach diffuse flow documentation.
2.
Stormwater Management Plan
2a.
Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250?
❑ Yes ® No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)? *
M Yes ❑ No
To look up low density requirements, click here:
http://reports.oah. state. nc. us/ncac/title%2015a%20-%20environmental%20guality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20 1003pdf
2c.
Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state -
❑ Yes El No
approved local government stormwater program? *
© n/a — project disturbs < 1 acre
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2d.
Which of the following stormwater management program(s) apply?
❑ Local Government
(Check all that apply.)*
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs t
❑ Phase II ❑ USMP
❑ NSW ❑ Water Supply
Page 16 of 21 PCN Form Version 4.3- April 20, 2022

Please identify which local government stormwater program you are using.
Click to enter.
State Stormwater Programs * ❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
Click to enter.
Page 17 of 21 PCN Form Version 4.3- April 20, 2022

G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local)
funds or the use of public (federal/state) land? y
❑ Yes © No
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 (North Carolina) Environmental
❑ Yes ® No
Policy Act (NEPA/SEPA)? r
1 c. If you answered "yes" to the above, has the document review been
finalized by the State Clearing House? (If so, attach a copy of the
❑ Yes ® No
NEPA or SEPA final approval letter.)
Comments:
A.^ e
C"`llck to enter.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A
NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300),
Federally Non -Jurisdictional Wetlands /Classified Surface Waters ❑ Yes Z No
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
Click to enter.
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
❑ Yes © No
downstream water quality?
3b. If you answered "no", provide a short narrative description:
Shoreline stabilization only
3c. If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdf)
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? * ❑ Yes 0 No ❑ N/A
4b. If yes, describe in detail the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity
available at that plant.
Click to enter.
Page 18 of 21 PCN Form Version 4.3- April 20, 2022

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? (IPAC weblink: https://www.fws.gov/ipac/ rfws.govl)
❑ Yes © No
5b. Have you checked with the USFWS concerning Endangered Species
Act impacts? *
® Yes ❑ No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another federal agency involved?
❑ Yes ® No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e. Is this a DOT project located within Divisions 1-8? '
❑ Yes ® No
5f. Will you cut any trees in order to conduct the work in waters of the
U.S.?
❑Yes ®No
59. Does this project involve bridge maintenance or removal? *
❑ Yes ® No
5g1. If yes, have you inspected the bridge for signs of bat use such as
staining, guano, bats, etc.? Representative photos of signs of bat use
❑ Yes ❑ No
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: http://saw-re.g.usace.army.mil/NLEB/1-30-17-signed NLEB-SLOPES&apps pdf
If you answered yes to 5g1, did you discover any signs of bat use?
❑ Yes ❑ No ❑ Unknown
If yes, please show the location of the bridge on the permit drawings/ project plans
5h. Does this project involve the construction/ installation of a wind
turbine(s)?
El Yes ©No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdf)
5i. Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
❑ Yes ® No
mechanized pile drivers, etc.? *
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdf)
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? *
I spoke with Brian Tompkins at USFW Asheville by phone on 1/4/2023 regarding the subject property and he
stated that ther are no concerns for any endangered species to be impacted by the proposed project.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat? * El Yes ®No
Is there submerged aquatic vegetation (SAV) around ❑ Yes © No ❑ Unknown
the project vicinity?
Page 19 of 21 PCN Form Version 4.3- April 20, 2022

Will this project affect submerged aquatic vegetation? I ❑ Yes © No ❑ Unknown I
Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Duke Energy FERC Map
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://qis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or
El Yes ®No
properties significant in North Carolina history and archaeology)?
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
http:/Igis.ncder.gov/hpoweb/
7c. Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?
® Yes ❑ No
8b. If yes, explain how the project meets FEMA requirements.
Existing shoreline stabilization and proposed maintenance project for existing stabilization to control and prevent
erosion
8c. What source(s) did you use to make the floodplain determination?
Iredell County GIS and Fema Floodplain Map
H. Miscellaneous
Comments:
Click to enter,
I Attach pertinent documentation or attachments not previously requested I
Page 20 of 21 PCN Form Version 4.3- April 20, 2022

I. Signature *
® By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: * Janice Estep for KPL Properties, LLC
Signature: * Janice Estep
Date: * 2/2/2023
Page 21 of 21 PCN Form Version 4.3- April 20, 2022