20110347 Ver 1_Shoreline Stabilization_20110412

201100141-
The following is an abbreviated application form for those applying for a 401 Water Quality
Certification to impact FERC (Federal Energy Regulatory Commission) regulated lake shore or
bottom under the U.S. Army Corps of Engineers ftm' GP30. This Application cannot be used
for wetland or stream impacts. Please provide seven copies of this application and supporting
information as well as a non-refundable application fee to the Division of Water Quality of $240.00
for impacts of to lake bottom of less than 1 acre and $570.00 for impacts to lake bottom of greater
or equal to 1 acre.
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center D
Raleigh, NC 27699-1650 VDA UM APR 12 2011
I. Applicant Information
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1. Owner/Applicant Information . - • •- - ?
Name: lGs A061n -Br+-?+ ? Sus,-h --le Bri4t
Mailing Address: (DUO 1 V 6hM OLc e,
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Telephone Number: 33(o- Zi g- Fax Number: 33 6 -299- 9,6V-(4_
Address: C bri 4+ tai ' rr , to"
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number.
E-mail Address:
H. Project Information
3 q- - / 3b 3 Fax Number.
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Attach a vicinity map clearly showing the location of the property with respect to local landmarks such
as towns, rivers, and roads. Also provide a detailed site plan showing property boundaries and
development plans in relation to surrounding properties. You may use the diagram below to make a
hand sketch of your project. Also, see the example below for guidance. Both the vicinity map and site
plan must include a scale and north arrow. The footprints of all buildings, impervious surfaces, or other
facilities must be included.
Location
County: 0 h Nearest Town:
Subdivision name or site address (include phase/lot number):
se-(hos-,t
7??n?,?baDr ul i I I ham. ??4C ?z 7 /
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included}: ? M tn`nse . on a If At 1-kf(,S u
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ei ("Q5+ h a!'d Z10nIGCI
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r4C, ' ioLoo cP poor w a I /ec! uvn I`t c?h ?n-}a irs+ dry vi a y rm I e -
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): 7 3 6 QC.re -s
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4. Nearest body of water (stream/river/sound/ocean/lake): l ?ike- a
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5. Describe the purpose of the proposed work. add rip
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b. List the type of equipment to be used to construct the project:
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: +50 5?rd J rZ f n+ro cK (Y'rp ra pJ
?I ow r a I o 1 IA-K? ?e-ve-1
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above thnormal pool a level d 50 feet I d-ward in uare feet or acres*
o ay`? re) r! yG l
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8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): -P- 47 ? s a-a Ce S iM-&-s5
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Applicant/Agenus signature ------
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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Please app 3dmdWV skdch the felowbig din on this plan
WMm p wAds moons for each Nan% smh as 10 R. x 100 Ry.
1) M proposed vegdMon cearhrg (pmvide r eneio??
A Limon of rip rap or fi® to be placed above the FjA Pond eUkmgtlon
9) Location of f1p rap or ftil to be pbced belm the PO Pond elevaflon
4) TM t rr of sw proposed dmetures It as buNd hg% retWnlnp
wars, docks, etc.
6) The kwi ion Of ex+cavdion or driedging below the Ftdt Pond
elevation.
8) l.ocegort ei caret acce conidore.
For. OLVI u e?s-1.0 0's ! 1 c ? d )A