20090602 Ver 2_401 Application_20130713

July 12, 2013
Cyndi Karoly
NCDENR
Division of Water Quality
Parkview Building
1650 Mail Service Center
Raleigh, NC 27699 -1650
RE: Waters Edge— Lake Wylie
Dear Ms. Karoly:
0 Lc o a_ 0 1--
SKIPJACK
Marine Development, LLG
858 Williamson Road
Mooresville, NC 28117
(704) 663 -3478 (866) 647 -8679 (FAX)
www.rowboatcomaany.com
Our firm is processing this application on behalf of Faison - Gaston Gateway LLC. This application for a
twenty-six slip commercial residential community dock which is based on Duke Energy and Federal
Energy Regulatory Commission guidelines. The community dock is to be located on Lake Wylie just
north of the I -85 Bridge in Mt. Holly, Gaston County, North Carolina.
The project was previously approved on June 17, 2009 (see attached approval). Before the project was
submitted to Duke Energy and FERC the Owner placed a hold on the project due to the economy. Given
the improving economy the Owner is now ready to move forward with the project. There are no changes
to the scope of work that was previously approved.
We request that your agency review the previously approved project and advise our firm if we can
proceed with the project under the current permit from 2009.
We look forward to hearing from you at your earliest convenience.
Sincerely,
SKIPJACK MARINE DEVELOPMENT
Michael Degner
Senior Designer
Enclosure: approval letter
a6�oe¢
JUL 1 8 2013

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
Mr Neil Kappadia
121 West Trade Street, 27`h Floor
Charlotte, NC 28202 -5399
Subject Property: Water's Edge, Lake Wylie
Dee Freeman
Secretary
June 17, 2009
DWQ# 09 -0602
Gaston County
Approval Of 401 Water Quality Certification And Authorization Certificate per the Catawba Riparian
Buffer Rule (15A NCAC 2B.0243) with Additional Conditions
Dear Mr. Kappadia:
You have our approval, in accordance with the general certification and those conditions listed below,
glace fill in or to otherwise impact/stabilize the following as described in your application dated June 4, 2009:
After reviewing your application, we have determined that N C. Division of Water Quality (DWQ) General Water
Quality Certification Number 3693 covers the impacts (a copy can be found at:
http //h2o.enr. state. nc us /ncwetlands. This Certification allows you to use Regional General Permit No.
198200030 when issued to you by the US Army Corps of Engineers (USACOE). This letter shall also serve as
your approved Authorization Certificate for impacts to the protected riparian buffers per 15A NCAC 2B .0243.
In addition, you should obtain or otherwise comply with any other required federal, state or local permits before
you proceed with your project, including (but not limited to) those required by Erosion and Sediment Control,
Non - Discharge, Duke Power, and Water Supply Watershed regulations
The above noted Certification will expire when the associated USACOE's 404 permit expires unless
otherwise specified in the General Certification. This approval is for the purpose and design that you described
in your application. If you change your project, you must notify this office and you may be required to submit a
new application. If the property is sold, the new owner must be given a copy of this Certification and approval
letter and is thereby responsible for complying with all conditions.
This approval requires you to follow the conditions listed in the attached Certification and any additional
conditions listed below.
Mooresville Regional Office One
Location- 610 East Center Avenue, Suite 301, Mooresville, NC 28115 NorthCarolina
Phone- (704) 663- 1699\Fax: [phone]\ Customer Service* 1- 877 -623 -6748 ��t�lrallr�
Internet www.ncwaterauality ora
Amount Approved (Units)
Plan Location or Reference
Shoreline
feet
404 /CAMA Wetlands
acres
Waters
acres
Buffers — Zone 1
600 (square ft.
Boardwalk 6 ft wide &
Buffers- Zone 2
240 (square ft.
Handicap lift
After reviewing your application, we have determined that N C. Division of Water Quality (DWQ) General Water
Quality Certification Number 3693 covers the impacts (a copy can be found at:
http //h2o.enr. state. nc us /ncwetlands. This Certification allows you to use Regional General Permit No.
198200030 when issued to you by the US Army Corps of Engineers (USACOE). This letter shall also serve as
your approved Authorization Certificate for impacts to the protected riparian buffers per 15A NCAC 2B .0243.
In addition, you should obtain or otherwise comply with any other required federal, state or local permits before
you proceed with your project, including (but not limited to) those required by Erosion and Sediment Control,
Non - Discharge, Duke Power, and Water Supply Watershed regulations
The above noted Certification will expire when the associated USACOE's 404 permit expires unless
otherwise specified in the General Certification. This approval is for the purpose and design that you described
in your application. If you change your project, you must notify this office and you may be required to submit a
new application. If the property is sold, the new owner must be given a copy of this Certification and approval
letter and is thereby responsible for complying with all conditions.
This approval requires you to follow the conditions listed in the attached Certification and any additional
conditions listed below.
Mooresville Regional Office One
Location- 610 East Center Avenue, Suite 301, Mooresville, NC 28115 NorthCarolina
Phone- (704) 663- 1699\Fax: [phone]\ Customer Service* 1- 877 -623 -6748 ��t�lrallr�
Internet www.ncwaterauality ora

1. The Mooresville Regional Office shall be notified in writing once construction at the approved impact
areas has commenced.
2. No impacts shall occur in the buffer from top of bank, including the removal of trees and soil disturbance.
3. The access corridor shall be restored to its original state.
4. Staging shall occur, and any spoil shall be stockpiled, outside of Zone 1.
5. All storm water shall be directed as diffuse flow at non - erosive velocities through the protected
lake /stream buffer and will not re- concentrate before discharging into the lake /stream as identified within
15A NCAC 2B.0243(5).
6. Upon completion of all work approved by this 401 Water Quality Certification, and any subsequent
approved modifications, the applicant is required to return the attached Certificate of Completion form to
the 401 Oversight/Express Review Permitting Unit, North Carolina Division of Water Quality, 1650 Mail
Service Center, Raleigh, NC, 27699 -1650.
Violations of any condition herein set forth may result in revocation of this Certification and may result in
criminal and /or civil penalties. If you do not accept any of the conditions of this Certification (associated with
the approved wetland or stream impacts), you may ask for an adjudicatory hearing. You must act within 60
days of the date that you receive this letter. To ask for a hearing, send a written petition, which conforms to
C"gpter 150B of the North Carolina General Statutes, to the Office of Administrative Hearings, 6714 Mail
;ice Center, Raleigh, N.C. 27699 -6714. This Certification and its conditions are final and binding unless
you ask for a hearing.
Any disputes over determinations regarding this Authorization Certificate (associated with the approved
buffer impacts) shall be referred in writing to the Director for a decision. The Director's decision is subject to
review as provided in Articles 3 and 4 of G.S. 150B.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act and the Catawba Riparian Buffer Rule as described within 15A NCAC 2B .0243. If you have any
questions, please telephone Cyndi Karoly at 919 - 733 -1786 or Alan Johnson at 704 - 663 -1699.
Sincerely,
J
for Coleen H. Sullins
Enclosure
cc: Ian McMillan, Wetlands Unit
Duke Energy Lake Services, PO Box 1006, Charlotte, NC 28201 -1006
Rowboat Dock/Dredge

May 20, 2009
Cyndi Karoly
NCDENR
Division of Water Quality
Parkview Building
2321 Crabtree Boulevard
Raleigh, NC 27604
RE: Waters Edge - Lake Wylie
Dear Ms. Karoly:
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SKIPJACK
Marine Development, LLC
858 Williamson Road
Mooresville, NC 28117
(704) 663 -3478 (866) 6474678 (FAX)
www.rowboatcompany.com
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JUN 4 2009
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Our firm is processing this application on behalf of Faison - Gaston Gateway LLC. This application for a
twenty-six slip commercial residential community dock which is based on Duke Energy and Federal
Energy Regulatory Commission guidelines. The community dock is to be located on Lake Wylie just
north of the I -85 Bridge in Mt. Holly, Gaston County, North Carolina.
The purpose of this facility is to provide twenty-six day docks providing access to Lake Wylie for the
residents of Waters Edge, a residential development. Approximately 1520 CY of material will be
excavated to provide boating access to the docks.
The community docks will be configured in accordance with the enclosed drawings. The docks will be
commercial quality utilizing a galvanized steel truss system, decked with composite decking and floated
using poly - encapsulated floatation. The dock will be moored in place using telescopic steel pilings. We
have enclosed a project summary, drawings and maps pertinent to this project.
We request that your agency review the enclosed plan and advise our firm of any regulatory concerns,
which you may have relative to this application.
We look forward to hearing from you at your earliest convenience.
Sincerely,
SKIPJACK MARINE DEVELOPMENT
E. Carey Ayres, P.E.

WATER'S EDGE
RESIDENTIAL MARINA
PROJECT SUMMARY
Faison - Gaston Gateway LLC, the applicant, is proposing the installation of a 26 slip
residential marina to serve the residents of their Water's Edge, 285 residential town home
community located adjacent to Lake Wylie on approximately 18.7 acres in Gaston
County, North Carolina. Of the approximately 1104.1 feet of eligible shoreline,
approximately 503.73 feet or 45% will be preserved. A 100' buffer will remain in place
along the reservoir. A pedestrian walkway and 5 dedicated parking spaces will provide
access to the facility.
The proposed marina project consists of one dock cluster with 26 slips, an associated
boardwalk/fixed pier and loading ramp. The docks will be accessed via a land bridge
(pier) constructed of a pressure treated wood frame structure with TREX decking. An
aluminum ramp will be used to transition from this structure to the floating docks. The
floating docks will be constructed of a commercial quality hot dipped galvanized angle
braced steel truss system, with encapsulated floatation billets.
The marina will accommodate 26 watercraft and is configured as follows:
• Thirteen (13) double loaded 24'X24'berths to accommodate twenty six (26) boats
• Eight foot wide main walkways
• Four foot wide forger piers
• Galvanized steel telescopic piles
Approximately 1,520 CY of material will be dredged to provide boating access to the
marina.
This project is shown on the attached drawings.

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Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre - Construction Notification C Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
® Section 404 Permit ® Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number. or General Permit (GP) number: 198200030
1 c. Has the NWP or GP number been verified by the Corps?
FO Yes ® No
1 d. 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 in4ieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
0 Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
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:
Water's Edge - Lake Wylie
2b. County:
Gaston County n -
F la
2c. Nearest municipality / town:
Mount Holly I
2d. Subdivision name:
Water's Edge JUN
2e. NCDOT only, T.I.P. or state
project no:
' W+T W
3. Owner Information 4'6ZBRA'dCFt
3a. Name(s) on Recorded Deed:
Faison - Gaston Gateway LLC
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
L5 W Lau V1
Neil Kaphadia W L U V/ 0
3d. Street address:
121 West Trade Street, 27"' Floor JUL 1 g
3e. City, state, zip:
Charlotte, NC 28202 -5399
704972 -2500 Mile-, �;qw;�RftnmrA
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Neil.Kapadia @faison.com; [e-mail]
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:
SAME
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Inforration (if applicable)
5a. Name:
N/A
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
59. 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
1 a. Property identification no. (tax PIN or parcel ID):
216577
Latitude: 35 15.57.28 N Longitude: - 81
1 b. Site coordinates (in decimal degrees):
01.01.83 W
(DD.DDDDDD) (- DD.DDDDDD)
1 c. Property size:
18.7 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Lake Wylie
proposed project:
2b. Water Quality Classification of nearest receiving water.
2c. River basin:
Catawba River
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:
Residential
3b. List the total estimated acreage of all existing wetlands on the property:
N/A
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
N/A
3d. Explain the purpose of the proposed project:
Installation of a 26 slip marina. This will be assembled off -site and floated to its design location. Access to the floating
docks will be a 6' wide boardwalk transitioning to a fixed pier. Approximately 1,520 cubic yards of silt will be dredged
from Lake Wylie to provide boating access to these docks. This project will provide access to the lake for residents of this
community.
3e. Describe the overall project in detail, including the type of equipment to be used:
Installation of a 26 slip marina. This will be assembled off -site and floated to its design location. Access to the floating
docks will be a 6' wide boardwalk transitioning to a fixed pier. Minimal underbrushing will be required for the installation
of the boardwalk. Dredging will occur only in months allowed by Duke Energy's SMP. Dredging will be accomplished
utilizing barge mounted excavator and cargo barges. The dredge spoils will disposed of at an approved off -site location. .
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
0 Yes ❑ No ® Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
C] 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.
S. Project History
5a. Have permits or certifications been requested or obtained for
El Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to 'help file" instructions.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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. 20. 2e. T 2f.
Type of jurisdiction
Wetland impact
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
DWQ — non -404, other) (acres)
Permanent (P) or (if known)
Temporary
❑Yes
❑ Corps
W1 ❑ P ❑ T
N/A
❑ No
❑ DWQ
❑Yes
❑Corps
W2 [:]PC] T
❑ No
❑ DWQ
❑Yes
❑Corps
W3 P ❑ T
❑
❑ No
❑ DWQ
C3 Yes
❑Corps
W4 ❑ P ❑ T
❑ No
❑ DWQ
❑Yes
❑Corps
W5 [] P C1 T
❑ No
❑ DWQ
❑Yes
[I Corps
W6 ❑ P [IT
❑ No
❑ DWQ
2g, Total wetland impacts
2h. Comments: N/A
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. 39
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
length
PER or stream
number - (PER) (Corps - 404, 10
width (linear
Permanent (P) or intermittent DWQ — non-404,
(INT)? other) (feet) feet)
Temporary (T)
❑ PER
❑ Corps
Si ❑ P ❑ T
N/A
❑ INT
❑ DWQ
[I PER
❑ Corps
S2 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
[3 Corps
S3 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
C3 Corps
S4 [] P E] T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S5 P ❑ T
❑
❑ INT
❑ DWQ
❑ PER
❑ Corps
S6 ❑ P ❑ T
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
3i. Comments: N/A
Page 5 of 11
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
Lake Wylie
Dredge
Lake
0.31
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4E Total open water impacts
4g. Comments:
S. Pond or Lake Construction
If Pond or lake construction proposed, the complete 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
Filled
Excavated
Flooded
P1
WA
P2
R 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 an im acts 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
Buffer
mitigation
Zone 1 impact
(square feet)
Zone 2 impact
(square feet)
Permanent (P)
for impact
Stream name
required?
or Temporary
B1 ®P ❑ T
Boardwalk
Lake Wylie
❑ Yes
® No
600
240
❑Yes
B2 ❑ P ❑ T
❑ No
❑Yes
B3 ❑P ❑T
❑ No
6h. Total buffer impacts
600
240
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.
Dredging will occur only in months allowed by Duke Energy's SMP. The cluster dock will constructed off -site and floated to its
design location. Appropriate erosion control measures will be utilized during the construction of the boardwalk/fixed pier.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The dock will be constructed off site and floated to its design location. The boardwalk will require only minimal underbrushing.
The dredging will be accomplished by barge mounted equipment and spoils will be disposed of off -site at an approved
disposal site.
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 in4ieu fee program
❑ Permittee Responsible Mitigation
3. Complete If Using a Mitigation Bank
3a. Name of Mitigation Bank: NIA
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
Page 7 of 11
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. Cl Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ❑ warm ❑ cool Ocold
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:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a pennittee responsible mitigation plan, provide a description of the proposed mitigation plan.
N/A
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWO
6a. Will the project result in an impact within a protected riparian buffer that requires
❑ Yes ❑ No
buffer mitigation?
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.
6c.
Reason for impact
6d.
Total impact
Multiplier
6e.
Required mitigation
(square feet)
Zone
(square feet)
3 (2 for Catawba)
Zone 1
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,
pennittee 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:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
N/A %
2b. Does this project require a Stormwater Management Plan?
❑ Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
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?
N/A
❑ Phase II
❑ NSW
3b. Which of the following locally - implemented stormwater management programs
❑ 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 Program Review
❑ Coastal counties
❑ HQW
4a. Which of the following state - implemented stormwater management programs apply
[3 ORW
(check all that apply):
❑ Session Law 2006 -246
❑ Other. N/A
4b. Has the approved Stormwater Management Plan with proof of approval been
Yes E] No
attached?
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 L Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/statetiocal) 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
❑ Yes ❑ No
environmental document pursuant to the requirements of the National or State
(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
❑ Yes ❑ No
letter.)
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
❑ Yes ® 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.
N/A
Page 10 of 11
PCN Form —Version 1.3 December 10, 2008 Version

6. 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?
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
® Asheville
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. 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?
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?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain?
❑ Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
06!02/09
Applicant/Agent's Printed Name
ApplicantlAgent's Signature
(Agent's signature is valid only N an authorization letter from the applicant
Date
is provided.)
Page 11 of 11
PM Firm — Vpminn 1 3 December 10. 2008 Version

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