20220974 Ver 1_401 Application_20220623

Staff Review Form
NORTH CAROLINA
EnNmnmenfei Qea(Uy
Updated September4, 2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID# *
20220974
Version* 1
Is this project a public transportation project?*
Reviewer List:*
Select Reviewing Office: *
Submittal Type:*
Yes
No
Paul Wojoski:EADS\pawojoski
Central Office - [phone]
401 Application
Does this project require a request for payment to be sent?*
Yes
No
How much is owed?* $240.00
$570.00

Project Submittal Form
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Project Type: *
For the Record Only (Courtesy Copy)
New Project
Modification/New Project with Existing ID
More Information Response
Other Agency Comments
Pre -Application Submittal
Re-Issuance\Renewal Request
Stream or Buffer Appeal
Pre -Filing Meeting Date Request was submitted on:
4/28/2022
Project Contact Information
Name: Jennifer Scott
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: Fontana Floating Cabin
Is this a public transportation project?
Yes
• No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes ® No Unknown
County (ies)
Swain
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
TVA 401 Letter.docx.pdf 49.96KB
PCN_FillableForm2022.pdf 367.92KB
TVA SCAN1.pdf 4.9MB
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
Included is Letter to explain need for 401 Permit
401 Application
401 PreFile Meeting Request
TVA ownership change and Plan View For Floating Cabin
Sign and Submit

By checking the box and signing box below, I certify that:
• I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief.
• I, 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.
• I agree that submission of this online form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a
written signature; AND
• I intend to electronically sign and submit the online form.
Signature:
Submittal Date: Is filled in automatically.

June 22, 2022
Paul Wojoski
401 & Buffer Permitting Branch Supervisor
512 N. Salisbury Street (Archdale Building), Suite 942-E
Raleigh, NC 27604
Dear Paul,
I am contacting you to apply for a 401 Certification. My husband and I purchased an
existing floating cabin that had been properly removed from Fontana Dam and given
permission from the TVA to rebuild to exact square footage and specs. I have included
with this email, a copy of my pre -filling meeting certification that I requested on April 28,
2022. 1 contacted Andrew W. Moore, from the NCDEQ-Division of Water Resources,
and he help me complete the 401 Application, as a new form for Floating Cabins is not
available yet. I have also included a copy of the TVA letter giving us permission to
rebuild the floating cabin. We understand that after completing the process of getting a
401 Certification, we will need to apply for a 26A Permit to rebuild. We are going to be
mooring the floating cabin with Alarka Boat Marina near the Greasy Branch Marina. The
black and grey water will be collected by the marina and disposed properly. If there is
anything that I have forgotten to complete for this 401 Application, please feel free to
email me at iennallennc(d)-gmail.com. Thank you.
Sincerely,
Mikael and Jennifer Scott
2053 Matlock Creek Road
Franklin NC 28734
[phone]

x STAi�
� ea o. nan NO
o
e vuw
NORTH CARCLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action I D no. [Click to enter.] Date received: [Click to enter.]
DWR project no. Dlick enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): [Click to enter.]
Longitude (DD.DDDDDD): [Click to enter.]
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:
httas://edocs.dea. nc.aov/WaterResources/DocView.asax?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 401 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) : 4/28/2022
Page 1 of 20 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located:
Choose one. Additional (if needed).
Is this a NCDMS project?
(Click yes only if NCDMS is the applicant or co-
❑ Yes ❑x No
applicant)
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes ❑x No
or airport project)
Is this a NCDOT project?
❑ Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number:
Click to entF
❑ Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
la. Type(s) of approval sought from the Corps:
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted?
❑ Yes ❑x No
Please provide the date of the previous submission.
Click to enter a date.
❑ Nationwide Permit (NWP)
1 b. What type(s) of permit(s) do you wish to seek
❑ Regional General Permit (RGP)
authorization?
❑ 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.
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes ❑x No
NWP number(s) (list all numbers ):
Click to enter.
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
❑ Yes ❑x No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act
Click to enter text.
1d. Type(s) of approval sought from DWR (check all that apply):
❑x 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 ❑x 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 ❑x No
Page 2 of 20 PCN Form Version 4.3- April 20, 2022

1g.
Is payment into a mitigation bank or in -lieu fee program proposed for
❑ Yes
❑x No
mitigation of impacts?
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
❑ Yes
❑x No ❑ Unknown
Concern (AEC)? *
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 20 PCN Form Version 4.3- April 20, 2022

B. Applicant Information
1 a.
Who is the primary contact?
Jennifer Scott
1 b.
Primary Contact Email:
[e-mail]
1 c.
Primary Contact Phone: (###)###-####
[phone]
1 d.
Who is applying for the permit/certification? (check
all that apply)
® Owner ❑ Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?
❑ Yes 0 No
2.
Landowner Information
2a.
Name(s) on Recorded Deed:
Mikael and Jennifer Scott
2b.
Deed Book and Page No.:
click to ent�
2c.
Contact Person (for corporations):
Click to enter.
2d.
Address
Street Address:
2053 Matlock Creek Road
Address line 2:
Click to enter.
City:
Franklin
State/ Province/ Region:
NC
Postal/ Zip Code:
28734
Country:
USA
2e.
Telephone Number: (###)###-####
[phone]
2f.
Fax Number: (###)###-####
Click to entE
2g.
Email Address:
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name:
Click to enter.
3b.
Business Name (if applicable):
Click to enter.
3c.
Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: (###)###-####
Click to enter.
3e
Fax Number: (###)###-####
Click to enter.
3f.
Email Address:
Click to enter.
Page 4 of 20 PCN Form Version 4.3- April 20, 2022

4. Agent/ Consultant (if applicable)
4a. Name:
Click to enter.
4b. Business Name:
Click to enter.
4c. Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country:
Click to enter.
4d. Telephone Number: (###)###-####
Click to enter.
4e Fax Number: (###)###-####
Click to enter.
4f. Email Address:
Click to enter.
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/Reg ulatory- Perm it-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 20 PCN Form Version 4.3- April 20, 2022

C. Project Information and Prior Project History
1. Project Information
1 a. Name of project: *
New Floating Cabin
1 b. Subdivision name (if appropriate):
Click to enter.
1 c. Nearest municipality/town: *
Swain County/Bryson City
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
Click to enter.
2b.
Property size (in acres):
Click to enter
2c.
Project Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country:
Click to enter.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * [Click to enter.]
Longitude (-DD.DDDDDD): *-[Click to enter.]
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Fontana Lake
3b. Water Resources Classification of nearest receiving
Click to enter.
water: *
The Surface Water Classification map may be found at this link:
https:Hncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
Little Tennessee
3c. In what river basin(s) is your project located?
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
000006010202
located: *
The Find Your HUC map may be found at this link:
https:Hncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 20 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:
Click to enter.
4b. Have Corps permits or DWR certifications been obtained for this
❑ Yes ❑x No ❑ Unknown
project (including all prior phases) in the past?
If yes, please give the DWR Certification number and/or Corps
[Click to enter.]
Action ID (ex. SAW-0000-00000):
jClick to enter.]
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete?
❑ Yes ❑x No
If yes, describe the completed work.
UJUK W efltel teX1.
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 te)
4d. Attach an 8'h x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'h 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
Click to enter acres
property:
4g. List the total estimated linear feet of all existing streams (intermittent
Click to enter linear feet
and perennial) on the property:
4g1. List the total estimated acreage of all existing open waters on the
Click to enter acres
property:
4h. Explain the purpose of the proposed project:
New Build Floating Cabin
4i. Describe the overall project in detail, including the type of equipment to be used:
Click to enter text
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.
Click to enter text
Page 7 of 20 PCN Form Version 4.3- April 20, 2022

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on
the property or in
❑ Yes ❑x No ❑ Unknown
proposed impact areas?
Comments:
dick to enter text.
5b.
If the Corps made a jurisdictional determination,
❑ Preliminary ❑ Approved ❑ Emailed concurrence
what type of determination was made?
❑ Not Verified ❑ Unknown ❑x n/a
Corps AID number (ex. SAW-0000-00000):
—lick fn nn+a
Name (if known): Click to enter.
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Click to enter.
areas?
Other: Click to enter.
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
'link to PntPr
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑x 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 20 PCN Form Version 4.3- April 20, 2022

D. Proposed Impacts Inventory
Impacts Summary
❑ Wetlands ❑ Streams - tributaries
1 a. Where are the impacts associated with your project ❑ Buffers ❑ Open Waters
(check all that apply):
❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #
2a1.
Impact
Reason/Type
2b.
Impact
Duration
2c.
Wetland Type
2d.
Wetland Name
2e.
Forested
?
2f.
Jurisdiction
Type
2g.
Impact Area
(ac)
W1
Choose one
i emp/ Perm
Choose onE
:,lick to enter
Y/I\
;hoose one
Click to enter
W2
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
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
Y/N
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
Temp/ 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
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
2g1. 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 20 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
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S2
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Click to enter
Temp/ 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
dick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
;lick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
dick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
dick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Click to enter
Temp/ 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
Mick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Mick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
;lick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
lick 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
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch
impact:
Click to ent linear ft
3i2. Total permanent stream
impacts:
Click to ent, linear ft
M. Total temporary stream
impacts:
Click to entt linear ft
34. Total stream and ditch
impacts:
Click to ent, linear ft
3j. Comments:
UICK to enter.
Page 10 of 20 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.
Site #*
4a1.
Impact Reason
4b.
Impact
Duration*
4c.
Waterbody Name*
4d.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
dick to ent(
Temp/ Perm
Click to enter.
Choose one
:hoose one
Click to enter.
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
-hoose 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 enter.
Choose one
Choose one
Click to enter.
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Click to enter.
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.
ente
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
ente,
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Clicl
enter.
enter.
enter.
enter.
enter.
enter.
enb
5g.
Comments:
Click to enter.
5h.
Is a dam high hazard permit required?
❑ Yes ❑x 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 20 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.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: Click to ente
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)
B1
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
1311
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. 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: Click to enter sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
UICK to enter.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of 20 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:
:.lick to enter.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
Click to enter
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 ❑ Mitigation Bank
project? (check all that apply) ❑ 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 'ick 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 RIBITS website: (Please use the filter and select Wilmington district)
https://ribits.usace.army.miI/ribits apex/f?p=107:27:2734709611497::NO: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:
lick to enter.
Page 13 of 20 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.
�lirk to nntar
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
❑ Yes ❑ No
that requires buffer mitigation?
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.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(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
❑ Yes ❑ No
NC Division of Mitigation Services proposed?
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i.
Comments:
Click to enter.
Page 14 of 20 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
❑ Yes ❑ No
identified within one of the NC Riparian Buffer Protection Rules?
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://deg.nc.,qov/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
❑ 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)?
❑ Yes ❑ No
To look up low density requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20guaIity/chapter%2002%20-
%20environ mental%20manage ment/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
❑ Yes ❑ No
reviewed and approved under a state stormwater program or state -
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.
❑ Phase II ❑ USMP
Local Government Stormwater Programs
❑ NSW ❑ Water Supply
Page 15 of 20 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 16 of 20 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)
❑ Yes ❑x No
funds or the 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 (North Carolina) Environmental
El Yes El No
Policy Act (NEPA/SEPA)?
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:
Click 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 ❑x 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):
UlICK 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 ❑x No
downstream water quality?
3b. If you answered "no", provide a short narrative description:
Click to enter.
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? 1 ® Yes ❑ 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.
Contract with Mooring Marina (Alarka Marina) to pump and dispose of all black and grey water
Page 17 of 20 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
❑ Yes ❑x No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ ffws.govl)
5b. Have you checked with the USFWS concerning Endangered Species
❑ Yes ❑x No
Act impacts? *
5c. If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d. Is another federal agency involved? *
❑ Yes ❑x No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e. Is this a DOT project located within Divisions 1-8? *
❑ Yes ❑x No
5f. Will you cut any trees in order to conduct the work in waters of the
U.S.? *
❑ Yes ❑x No
5g. Does this project involve bridge maintenance or removal? *
❑ Yes ❑x 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-reg.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)? *
❑ Yes ❑x 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 ❑x 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? *
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? *
❑ Yes ❑x No
Is there submerged aquatic vegetation (SAV) around
the project vicinity? *
El Yes ❑x No El Unknown
Will this project affect submerged aquatic vegetation? *
❑ Yes ❑x No ❑ Unknown
Page 18 of 20 PCN Form Version 4.3- April 20, 2022

Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Click to enter.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://gis. ncdcr.,qov/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
❑ Yes ❑x 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? *
Click to enter.
7c. Attach historic or prehistoric documentation.
8.
Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:Hmsc.fema.,qov/portal/search
8a.
Will this project occur in a FEMA-designated 100-year floodplain? *
❑ Yes ❑x No
8b.
If yes, explain how the project meets FEMA requirements.
Click to enter.
8c.
What source(s) did you use to make the floodplain determination?
Click to enter.
H. Miscellaneous
Comments:
Click to enter.
Attach pertinent documentation or attachments not previously requested
Page 19 of 20 PCN Form Version 4.3- April 20, 2022

I. Signature *
❑x 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: * Jennifer Scott
Signature: * Jennifer Scott
Date: * 6/2/2022
Page 20 of 20 PCN Form Version 4.3- April 20, 2022

401PreFile
Automatic reply: [External] 401 Pre -filing Meeting Request
Apr 28, 2022 at 12:07:02 PM
Jennifer Allen
This email confirms receipt of your pre -filing meeting request. Please retain this email
for your records and submit this documentation as part of your 401 application (PCN
Application) as required by federal law. DWR will not be able to accept your
application without this federally required documentation. 401 applications received
without documentation that a pre -filing meeting request was submitted at least 30
days prior will be returned as incomplete.
Responses to this email are not monitored.
Background
On April 6, 2022, the United States Supreme Court issued an order staying a lower
court's vacatur of the Trump Administration's 2020 "Clean Water Act ti n 401
Certification Rule" ("Federal Rule"). As a result of the United States Supreme Court
order, the Trump Administration's Federal Rule has sprung back into effect.
The Trump Administration's Federal Rule imposes additional procedural
requirements on applicants for 401 Certifications and on DWR's processing of those
applications. One requirement is that 401 applicants must request a pre -filing
meeting request at least 30 days prior to submitting their 401 application. [40 C.F.R.
§121.4] In turn, the Federal Rule requires that applicants include documentation of
their pre -filing meeting request in their 401 Certification application. [40 C.F.R
§121.1; 40 C.F.R. §121.5]. Please refer to the Federal Rule for more information.
Per 40 CFR §121 and §121.5, a 401 Certification application that does not include
the required pre -filing meeting request documentation does not constitute a
"certification request." As a result of the reinstatement of the Trump Administration's
Federal Rule, all 401 applications received after April 6, 2022 that do not have
documentation that a pre -filing meeting request was submitted at least 30 days prior
to submittal of a 401 Certification application will be returned as incomplete.
If you need to contact 401 /Buffer Permitting Staff, please use the following link(s) to
access of staff contact lists).
For Non -Transportation Central Staff:
https://deq, c.gov/about/divisions/water-resources/water-quality-permitting/401-
uffer-permitting/401-buffer-permitting&9ntacts

TENNESSEE
VALLETVA Y
AUTHORITY
40C West Summit Hill Drive, Knoxville, Tennessee 37902
April 5, 2022
Mr. and Mrs. Mikael and Jennifer Scott
2053 Matlock Creek Road
Franklin, North Carolina 28734
Dear Mr. and Mrs. Scott:
FONTANA RESERVOIR — FONTANA VILLAGE MARINA — FLOATING CABIN UID 4528 —
FLOATING CABIN CHANGE IN OWNERSHIP CONFIRMATION
This confirms receipt of the change in ownership for floating cabin 4528 and that you are the
current owner. Your registration form satisfies the requirement to register your floating cabin.
TVA has assigned ID 4528 to your floating cabin. Please ensure that the orange tag with your
ID number, which was mailed to the previous owner, is affixed to the most lakeward side on a
readily visible part of the outside of your floating cabin.
Please review the enclosed documentation to ensure that the TVA plans on record align with
your structure. Registration is not an approval of your structure, nor is it a guarantee that your
structure can be approved by TVA Final regulations have been published and are effective on
October 12, 2021. Floating cabins must comply with those standards in order to receive a
Section 26a permit. Please visit www.tva.com/floatingcabins for updates on the regulations and
additional information about the floating cabin program.
Current regulations are published in Part 1304 of Title 18 of the Code of Federal Regulations
and can be reviewed on TVA's website at https://www.tva.com/26aregulations. No
modifications to your floating cabin or attached structures can be made without prior written
approval from TVA,
If you have any questions regarding this letter or if there are inaccuracies in your registration
documentation, please contact the Floating Cabin team at [e-mail].
Sincerely,
David B. Harrell, Program Manager
Recreation and Shoreline Management
Natural Resources
Enclosure

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TVA RESTRICTED INFORMATION
Tennessee Valley Authority
Floating Cabin Registration Form
Owner #1 Mailing information {Required)
Name L 1
a �
street . II a_oc NL y
City 1 Ll ' State` Zip code �
Email Address l )( "' } Xt
Home Phonej
Mobile Phone
Location of Floating Cabin (Required - include all known information)
Reservoir._ ] AJ,(_ _ GPS Coo
Stream Name and Mile CS «k
5
Marina Name 'o"s c
OMB No, 3316-0060
Exp. Date 06/3012022
Owner #2 Mailing information
� LL
Name L}
Street
City State AC Zip code -41
Email Address , 4Li a ka ij 1 Gv r
Home Phone —� r
Mobile Phone
nCz
Mooring Space Number,
If the floating cabin is not located at a marina, provide the address of the private property where the floating cabin is moored
State Zip Cade
Subdivision, Lot No., andlor Tax Parcel No
ADDITONAL REQUIRED INFORMATION
TVA Section 26a Permit
Is your floating cabin permitted by TVA? 0 No 31 If yes, please specify the permit number(s)
Electrical Service, Sanitation, Mooring and Anchoring
How is your floating cabin electrical service provided?
❑ The marina provides my electrical service and owns the meter, 0 1 have a separate meter and the local power company bills me.
CS have on -board power sources such as generators• solar panels. batteries.
I Other (please specify)
How is your gray water (showers, sinks, etc.) managed?
�❑ oEding tanks 12 Marine sanitation device ❑ Direct land -based utility connection ❑ Untreated discharge
❑ Other (please specify)
How is your black water (sewage) managed?
Holding tanks ❑ Marine sanitation device ❑ Direct land -based utility connection ❑ Untreated discharge
❑ Other (please specify)
How is your floating cabin moored or anchored?
❑ In a marina slip (10warina buoy line ❑ independently anchored
0 Other (please specify)
Drawing
Include a drawing showing the existing dimensions of the floating cabin (view from above). Include the dimensions of the enclosed space, attached
docks, walkways, floats, etc. Include a profile drawing (view from the side) showing the height of the floating cabin.
Photo
Include at least two photos of the floating cabin. The photos should include the front and back sides of the floating cabin, any attached structures
(slips, decks, etc.), and any identifying numbers (TVA or State) in the photo.
TVA 21158106-19-20191 Page 1 of 2
TVA RESTRICTED INFORMATION

TVA RESTRICTED INFORMATION
Tennessee Valley Authority OMB No.3316-0060
Floating Cabin Registration Form Exp. Date 0613012022
ADDITIONAL INFORMATION [Optional]
Include any information about your floating cabin that may he beneficial for TVA to know. This may include identifying numbers or signs on the
floating cabin,
Iorother info rmaeti/on,4 C
ilk ck
4;1
SIGN AND SUBMIT THE REGISTRATION
Sign the Form and submit the registration form, drawing, and photos to the following TVA mailing or email address.
Mailing Address
Tennessee Valley Authority
Floating Cabin Program Manager
400 West Summit Hill Drive, WT 111
Knoxville, Tennessee 37902
Email Address: [e-mail]
Signature (Required)
f certify that 1 am familiar with the information contained in this registration, and that to the best of my knowledge and belief such information is true,
complete, and accurate. I further certify that I am the owner of this floating cabin and possess the authority to register the structure. I understand and
agree that this registration does not constitute approval by TVA, within the meaning of Section 26a of the TVA Act, of any structures, utilities, or other
facilities described in this registration. I understand and agree no construction of any structures, utilities, or fat" ies req 'red under Section 26a will
occur un71ans for uch structures, utilities or facilities] have been submitted to TVA for approval in actor ce with blished ocedures.
[/• ,� Vie.
ODa(Printed) Dwner z�
Owner 1 me Signature
J �C�41 r) rl��6�
Date wn arne (Printed) O-
ne ignatu
16 1Section 1001 provides that Whae in any manner within the juhsdiction of any department or agen The United States knowingly and willfully falsifies,
corkcaels, or covers up by any trick, scheme, device it material fact or makes any false, fictitious or fraudulent statements or representations or makes or uses any false
writing or document knowing same to contain any false, frctitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five
years, or both.
Privacy Act Statement
This information is being requested in accordance with Section 28a of the TVA Act as cited on the front page of this form. Disclosure of the information requested is
voluntary; however, failure to provide any required information or documents may result in a delay in processing your application or in your being denied a Section 26a
permit. An application that is not complete will be returned for additional information. TVA uses this irformation to assess the impact of the proposed project on TVA
programs and time environment and to determine it the project can be approved. Information in the application is made a matter of public record through issuance of a
public notice if warranted. Routine uses of this information include providing to federal, state, or local agencies, and to consultants, contractors, etc., for use in program
evaluations, studies, or other matters involving support services to the program; to respond to a congressional inquiry concerning the application or Section 26a program;
and for oversight or similar purposes, corrective action, litigation or law enforcement.
Burden Estimate Statement
Public reporting hurden for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any
Other aspect of this collection of information, including suggestions for reducing this burden to Agency Clearance Officer. Tennessee Valley Authority, 1101 Market Street,
Chattanooga, Tennessee 37402. and to the Office of Management and Budget, paperwork Reduction Project 13318-0060j, Washington, D C- 20503.
TVA 21158 [06-19-20191 Page 2 of 2
TVA RESTRICTED INFORMATION