20130050 Ver 1_401 Application_20130113

20130050
r OF W A'r,
1 O� OG Office Use Only:
i Corps action ID no.
° ` DWQ project no.
L = Form Version 1.3 Dec 10 2008
Pre - Construction Notification C Form
A. AppHcant Information
1. Processing
s ,
1a. Type(s) of approval sought from the
Corps:
1
❑ Section 404 Permit ® Section 10, Permit
1 b. Specify Nationwide Permit (NWP) number. 42 or General Permit (GP) number
1c. Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ® Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
® Yes ❑ No
For the record only for Corps Permit:
® Yes ❑ No
1f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project information
2a. Name of project:
Latta Plantation Nature Preserve Kayak Pier /Launch
2b. County:
Mecklenburg
2c. Nearest municipality / town:
Charlotte
2d. Subdivision name:
NA
2e. NCDOT only, T.I.P. or state
project no:
NA
3. Owner Information
3a. Name(s) on Recorded Deed:
Mecklenburg County
3b. Deed Book and Page No.
06979 -306
3c. Responsible Parry (for LLC if
applicable):
Micheal Kirschman/David Suddreth
3d. Street address:
5841 Brookshire Blvd.
3e. City, state, zip:
Chariotte, NC 28216
013
3f. Telephone no.:
704336 -8467
3g. Fax no.:
704336 -5472
p NR - H ()U
Branch
3h. Email address:
david. suddreth @mecklenburgcountync.gov
_
Page 1 of 11
PCN Form —Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
02303115
1b. Site coordinates (in decimal degrees):
Latitude: 35.358889 Longitude: - 80.9175
(DD.DDDDDD) (- DD.DDDDDD)
1c. Property size:
323.58 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Mt. Island Lake/Catawba River
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS-IV
2c. River basin:
Catawba
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Site consists of existing lake shore on Mt. Island Lake within Latta Plantation Nature Preserve (heck County Park).
Mostly sandy shore line, clear of woody vegetation. Beach is currently being used for small boat launch and fishing.
Surrounding area is nature preserve /park being used for passive recreation.
3b. List the total estimated acreage of all existing wetlands on the property:
Unknown
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Unknown
3d. Explain the purpose of the proposed project:
To install a prefabricated floating pier designed to be used as a non - motorized (kayak/canoe) boat launch.
3e. Describe the overall project in detail, including the type of equipment to be used:
Project includes installing a prefabricated floating pier at an existing clearing along the bank of Mt. Island Lake. Clearing
is at the end on an existing un -paved gravel road. Installation will include the paving of a concrete sidewalk leading from
an adjacent gravel road/small parking area to the proposed concrete pier abutment that is to be installed on the shoreline
approximately 2' above the full pond elevation. All site work will be completed using small excavation equipement (rubber
tired back- hoe/loader, bob -cat type skid -steer loader), and hand labor. All concrete shall be formed and poured and the
prefabricated pier will be attached to proposed concrete pier abutment. (see attached drawings). The prefabricated pier
is modular. Pieces will be assembled on site then floated into place.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes ®No ❑Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency /Consultant Company:
Name (if known):
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
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PCN Form — Version 1.3 December 10, 2008 Version

6. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
Yes No Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Page 4 of 11
PCN Form —Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑ Streams - tributaries ® Buffers
® Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary m
(INT)?
other)
(feet)
feet)
S1 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
[:11 NT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
3i. Comments:
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PCN Form — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
Open water
impact number
— Permanent
(P) or
Temporary
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody type
4e.
Area of impact (acres)
01 ® P ❑ T
Mt. Island Lake
Pier abutment, and pre -fab pier
Lake
.10
02 []PDT
03 ❑P ❑T
04 ❑P ❑T
4E Total open water impacts
1
4g. Comments:
S. Pond or Lake Construction
If pond or lake construction proposed, then com lete the chart below.
5a.
Pond ID
number
5b.
Proposed use or purpose of
pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
I Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
❑ Neuse ❑ Tar - Pamlico ❑ Other.
Project is in which protected basin?
® Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason for
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P)
impact
Stream name
mitigation
(square feet)
(square feet)
or Temporary
required?
B1 ❑ P ® T
Construction
Catawba (Mt. Island Lake)
® Nos
500
700
B2 ❑P
El Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h. Total buffer impacts
500
700
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Location was selected based on its current use as a small boat launch. This pier installation will eliminate further use of and
deterioration of the lake shoreline by providing an improved method of lake access for small boat launch (canoes/kayaks).
This location does not require any further removal of shoreline woody vegetation and will allow the damaged shoreline area to
be repaired.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Construction will performed in ways that will avoid and /or minimize any impacts to the lake. Erosion control measures (silt
fence, etc.) will be used to stop sediment from running into lake. Construction will occur when water levels are lower than the
areas affected by the construction.All affected shoreline area will be matted and seeded, and shoreline vegetation will be
restored to currently eroded areas.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
❑ Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this project?
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: NA
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
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PCN Form —Version 1.3 December 10, 2008 Version

3c. Comments:
4. Complete If Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool []cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non - riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
6. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
S. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes No
Comments: There is no piped discharge. Only sheet flow.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
<1
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Very small, isolated area of disturbance,
with no concentrated or piped flow being created. Stormwater will remain the same as currently existing conditions.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
Mecklenburg County
® Phase II
3b. Which of the following locally- implemented stormwater management programs
® NSW
❑ USMP
apply (check all that apply):
® Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
4. DWQ Stormwater Prog ram Review
❑ Coastal counties
4a. Which of the following state - implemented stormwater management programs apply
❑ HOW
[] ORW
(check all that apply):
❑ Session Law 2006 -246
❑ Other.
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
S. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state /local) funds or the
® Yes ❑ No
use of public (federal /state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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
letter.)
❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
❑ Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
[:1 y e s No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
NA - None shall be generated or discharged.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑Yes ®No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
El Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
County Natural Resources Staff - Chris Matthews
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
County Natural Resources Staff - Chris Matthews
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
® Yes ❑ No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
Per the NC State GIS map of Historical Resources ( http: / /gis.ncdcr.gov/hpoweb/ ) there is an historic significant site
(Latta Plantation House) approximately 4000 LF away. There will be no negative impacts on this site due to this project.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain? --Fig
Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: Project will not have any impact on flood water surafce elevations.
8c. What source(s) did you use to make the floodplain determination? County & Fema FIRM Maps
0 &V I'Ck- Pef
—1;UAA .
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agents signature is valid only if an authorization letter from the applicant
is provided.)
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

HMEM
North Carolina DeDartmentof Environment and Natural Resources
an of Water Quality
G Beverly m W� Charles Director , P.E. Dee Freeman
Goverru �� Director Secretary
0-,Y'L (�-M CZ— N
Live Waters Management Strategy
\ - a. �• — l 3 ian Areas Rule (15A NCAC 02B.0243)
NOTE. This form may be photocopied for use as an original.
Part 1: General Information
(Please include attachments if the room provided is insufficient.)
1. Applicant's name (the corporation, individual, etc. who owns the property):
Mecklenburg County. Park & Recreation Dept.
2. Print Owner /Signing Official (person legally responsible for the property and its compliance)
Name:
David Suddreth
Title:
Project Inspector
Street address:
Meck County Park & Rec.
City, State, Zip:
5841 Brookshire Blvd, Charlotte, NC 28216
Telephone:
(704) 336 -8467
Fax:
(704) 336 -5472
3. Contact person who can answer questions about the proposed project:
Name: Same as Above.
Telephone: ( I
Fax: ()
Email: David. Suddreth @MecklenburgCountyNC.gov
4. Project Name (Subdivision, facility, or establishment name - consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
Latta Plantation Nature Preserve — Canoe /Kayak Launch Pier
Project Location:
Street address: 5225 Sample Road
City, State, Zip: Huntersville. NC 28078
County: Mecklenburg
Latitude/longitude: LAT: 35° 21' 32" N. LONG: 80° 55' 03" W
6. Directions to site from nearest major intersection (Attach an 8 '/z x 1 I copy of the USGS
topographic map indicating the location of the site).
From Beatles Ford Road at Sunset Rd, eo north on Beaties Ford, then take a Left on Sample
Road. Follow Sample Road until you enter Latta Plantation Park/Nature Preserve. After enterinis
park, follow entry road until you see the Equestrian Center on your right Take a right
immediately after equestrian center onto :travel road. Follow travel road untill it ends at lake.
Site is at end of gravel road
Version 2: March 2009

7. Stream to be impacted by the proposed activity:
Stream name (for unnamed streams label as "UT" to the nearest named stream):
Catawba River/Mt. Island Lake
8. Which of the following permits /approvals will be required or have been received already for this
project?
Required: Received: Date received:
Permit Type:
401 Certification/404 Permit
On -site Wastewater Permit
NPDES Permit (including stormwater)
Non - discharge Permit
Water Supply Watershed Variance
Erosion/Sedimentation Control
Others (specify)
Part 2: Proposed Activity
(Please include attachments if the room provided is insufficient.)
1. Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat map
or site plan in Adobe (pdf) format) to accurately delineate the boundaries of the land to be utilized
in carrying out the activity, the location and dimension of any disturbance in the riparian buffers
associated with the activity, and the extent of riparian buffers on the land. Include the area of
buffer impact in fe.:
Proiect includes installing a prefabricated floating pier at an existing clearing along the bank of
Mt. Island Lake. Existing clearing is at the end on an existing un -paved gravel road Installation
will include the paving of a concrete sidewalk leading from the adjacent gravel road /small parking
area to the proposed concrete /wood pier abutment that is to be installed on the shoreline
approximately T above the full pond elevation. All site work will be completed using small
excavation equipement (rubber tired back -lioe /loader, bob -cat type skid -steer loader) and hand
labor. All concrete shall be formed and poured and the prefabricated pier will be attached to
proposed concrete pier abutment. (see attached drawings) The prefabricated pier is modular.
Pieces will be assembled on site then floated into place. Land disturbance will be limited to the
areas being paved for sidewalk and the abutment installation. Area measures approximately 30' x
20' (500 SF) for abutment and 15' x 40' for the sidewalk (700SF). 1200 SF +/- total.
2. Fill in the table below to identify the square footage of impact to Zones 1 & 2 in the protected
riparian buffers and the required mitigation (Fill in the impacts portion of the table, even if
mitigation is not required):
Catawba Variance Request Form, page 2
Version 2: March 2009
Buffer Impact
Zone of
Impact in
Number
Purpose for
Multiplier
Required
Impact
Square Feet
(Indicate on
the Impact
Mitigation
Plan Sheet
Zone 1
500 SF max
Pier
2
construction
Zone 2
700 Max
1.5
Total
1200 SF max
Catawba Variance Request Form, page 2
Version 2: March 2009

*For the Catawba River mainstem, zone 1 extends out 30 feet perpendicular from the most landward limit of the top of bank
or the rooted herbaceous vegetation; Zone 2 extends an additional 20 feet from the edge of Zone 1. For mainstem lakes,
Zone 1 begins at the most landward limit of the full pond level and extends'landward 30 feet. Zone 2 extends an additional
20 feet from the edge of Zone 1.
State reasons why this plan for the proposed activity cannot be practically accomplished, reduced
or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
Riparian buffer at this location along the lakeshore is already compromised and deteriorating due
to use. This project will allow the area to be improved and stabilized, and will eliminate or
minimize future erosion. This project has been designed to solve existing erosion control, and
will be installed with minimal disturbance.
4. Description of any best management practices to be used to control impacts associated with the
proposed activity (i.e., control of runoff from impervious surfaces to provide diffuse flow, re-
planting vegetation or enhancement of existing vegetation, etc.):
Area will be protected with silt fence, matting, and /or hay bales in order to minimize erosion and
sediment. Site runoff /drainage will not be altered by this project. All disturbed areas and
adiacent eroded areas will be stabilized with boulders and matting, and all areas will be re- seeded
and re- vegetated.
S. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
Rule.
Construction of this roject would not be possible.
(2) How these difficulties or hardships result from conditions that are unique to the property
involved.
Direct shore access is required for installation and functionality of the pier.
(3) If economic hardship is the major consideration, then include a specific explanation of the
economic hardships and the proportion of the hardship to the entire value of the project.
There are no economic hardships
Part 3: Stormwater
1. Provide a description of all best management practices (BMPs) that will be used to control
sedimentation impacts associated with the proposed activity. Please ensure to include all
applicable operation & maintenance agreements and worksheets for the proposed BMPs. Also,
include the BMPs on your plan sheets.
NA. No BMP's are proposed. Sediment and erosion control measures will be in place d_ uring
construction (silt fence, matting, and /or hay bales will surround disturbed areas).
2. Attach a description of how diffuse flow will be maintained through the protected riparian
buffers. Please ensure to include all applicable operation & maintenance agreements and
worksheets for the proposed diffuse flow measure(s). Also, include the diffuse flow measure(s)
on your plan sheets.
NA. No changes or impacts will be made to site drainage.
Catawba Variance Request Form, page 3
Version 2: March 2009

3. Attach a detailed plan for all proposed structural stormwater BMPs.
IuI
Drainage
basin
Size of
drainage
basin
ac
Post - development
sediment loading
rate without BMPs°
Ibs/a r
BMP sediment
removal
efflcienc3 s
%
Final
sediment
loading rate
bs/a r
1
2
3
4
S
Totals
4 Attach calculations and references.
s Attach calculations and references.
Part 4: Water Quality Protection, continued
4. Attach all applicable supplement form(s) and Inspection and Maintenance (I &M) Form(s) to this
completed application. The applicable supplemental form(s) and I &M form(s) for the proposed
BMPs noted in your application can be downloaded from the following website:
hqp : //h2o.enr.state.nc.us/su/bmp forms.htm
WE
Part 5: Proposed Impacts and Mitigation
Provide a description of how mitigation will be achieved at your site pursuant to 15A NCAC
2B.0244.
If buffer restoration is the method you are requesting, be sure to include a detailed planting plan
to include plant type, date of plantings, the date of the one -time fertilization in the protected
riparian buffers and a plan sheet showing the proposed location of the plantings. A guide to
buffer restoration can be downloaded at the following website:
http:// www. nceep .neVnews /reports/buffers.pdf
If payment into a buffer restoration fund is how you plan to achieve your mitigation requirement,
then include an acceptance letter from the mitigation bank you propose to use stating they have
the mitigation credits available for the mitigation requested.
NA
Part 6: Deed Restrictions
By your signature in Part 5 of this application, you certify that all structural stormwater best
management practices required by this variance shall be located in recorded stormwater easements,
Catawba Variance Request Form, page 4
Version 2: March 2009

that the easements will run with the land, that the easements cannot be changed or deleted without
concurrence from the State, and that the easements will be recorded prior to the sale of any lot.
NA
Part 7: Applicant's Certification
I, D•v.'Jl 41kdlia fai k` (print or type name of person listed in
Part I, Item 2), certify that the information included on this permit application form is correct, that the
project will be constructed in conformance with the approved plans and that the deed restrictions in
accordance with Part 5 of this form will be recorded with all required permit conditions.
Signature:
Date:
Title:
1 019-1 11-14-
Mo &-..-
Part 8: Plan Sheets
Be sure to include a copy of all of your completed application form, plan sheets and maps in Adobe
(pdf) format on a CD or floppy disk.
Part 9: Checklist
A complete appplication submittal consists of the following components. Incomplete submittals will
be returned to the applicant. The complete variance request submittal must be received 90 days prior
to the EMC meeting at which you wish the request to be heard. Initial below to indicate that the
necessary information has been provided.
Applicant's
Item
Initials
nom/
• Original and two copies of the Variance Request Form and the attachments
listed below.
tL04-11
• A vicinity map of the project (see Part 1, Item 5)
Narrative demonstration of the need for a variance (see Part 2)
Calculations supporting sediment loading estimates (see Part 4)
• Calculations and references supporting sediment removal from proposed BMPs
(see Part 4)
KA
• Location and details for all proposed structural stormwater BMPs (see Part 4)
• Three copies of the applicable Supplement Form(s) and I &M Form(s) for each
BMP and/or narrative for each innovative BMP (see Part 4)
• Three copies of plans and specifications, including:
0 Development/Project name
0 Engineer and firm
0 Legend and north arrow
0 Scale (1" = 50' is preferred)
0 Revision number & date
0 Mean high water line (if applicable)
0 Dimensioned property/project boundary
0 Location map with named streets or NC State Road numbers
0 Original contours, proposed contours, spot elevations, finished floor
Catawba Variance Request Form, page 5
Version 2: March 2009

elevations
0 Details of roads, parking, cul-de -sacs, sidewalks, and curb and gutter
0 Footprint of any proposed buildings or other structures
0 Wetlands delineated, or a note on plans that none exist
0 Existing drainage (including off - site), drainage easements, pipe sizes,
runoff calculations
0 Drainage basins delineated
0 Perennial and intermittent streams, ponds, lakes, rivers and estuaries
0 Location of forest vegetation along the streams, ponds, lakes, rivers and
estuaries
Catawba Variance Request Form, page 6
Version 2: March 2009

Latta
Plantation
Park
Pier /Kayak
Launch
Duke Energy Pier
Permit Submittal
Sheet 1 of 3
Vivinity Map
Submitted by Mecklenburg
County Park & Recreation
Department
1/24/2011
MOTH SCALE: 1" = 1000'
Proposed pier to is located on Mountain
Island Lake, in Latta Plantaion Park /Nature
Preserve. Directions,(r om Charlotte: North
on I -77 to Exit 18. WaTel west and turn
right onto Beaties Ford Rd:. Travel north
and turn left off Beatties Ford Rd o
Sample Road. After entering the park take
a right immediately after the horse barn.
Follow gravel road until it ends. \Pier site is
/( at the road terminus.
Proposed Pier Location
Latitude: 35 21' 32" N
Longitude: 80' 55' 03" W
Island L /
Latta Plantation Park
=t E3
7- ""n, Y?
a
O_ • 119A
155N !1

Latta
Plantation
Park
Pier /Kayak
Launch
Duke Energy Pier
Permit Submittal
Sheet 2 of 3
Area Map
Submitted by Mecklenburg
County Park do Recreation
Department
1/25/2011
NO H SCALE: 1" = 50'
0
C/L of Cove
Proposed Pier/Kayak Lau
Full Pond Contour
p

Latta
Plantation
Park
Pier /Kayak
Launch
Duke Energy Pier
Permit Submittal
Sheet 3 of 3
Detail Map
Submitted by Mecklenburg
County Park k Recreation
Department
1/25/2011
T
NORTH SCALE: 1" = 20'
Centerline of C v
Notes:
-Pier Location: Mountain Island Lake,
Latta Plantation Park, Latitude: 35` 21'
32" N, Longitude: 80" 55' 03" 1f (owned by
Meckelenburg County)
-Total square footage of Proposed Lake
Lease Area: approx. 3350 SF.
-Total square footage of dock area
(covered lake area): approx. 450 SF.
-Total Area of additional impervious
surface (decking or pavement on land):
approx. 800 SF.
-Areas of eroded shoreline immediately
adjacent to proposed pier shall be
stabilized with a combination of boulders
and vegetation in order to eliminate
future bank erosion.
F