20041717 Ver 1_Complete File_20070831

Certificate of Completion
DWQ Project No.: O J- /7/'7
County: &;rAulBf-
Applicant:
Project Name: ?ko.Qel . f -L ' ? j', k, O .2 ?,PO d -76(
Date of Issuance of 401 Water Quality Certification: I?/o3/Ol/
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North
Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certification
I,-T???.t ??rGZ , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water QualitX Certification r es. the
approved plans and specifications, pffd? other supporting materials:
Signature: C Date: S' o JUN 1 2005
DENR - WATER QUALITY
Agent's Certification WETLANDS AND STORMWATER BRANCH
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Date:
If this project was designed by a Certified Professional
I, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permittee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to be built within substantial compliance and intent of the 401 Water Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature: Registration No.: Date:

TF9
pG
Af
??
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
December 3, 2004
DWQ Project # 04-1717
Catawba County
Greg Pollak
7971 Tradewinds Drive
Sherrills Ford, NC 28673
Subject Property: 2780 & 2766 Camden Pointe Drive on Lake Norman
Approval Of 401 Water Quality Certification And Authorization Certificate per the Catawba River
Buffer Protection Rules (15A NCAC 2B .0243) with Additional Conditions -
Dear Mr. Pollak:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact approximately 0.069 acres of waters and 7,144 square feet (ft) of protected
riparian buffers for the purpose of installing rip rap to stabilize approximately 376 feet of shoreline, as
described within your application dated October 25, 2004. After reviewing your application, we have
decided that the impacts are covered by the N.C. Division of Water Quality (DWQ) General Water
Quality Certification Number(s) 3373 (GC3373). The Certification(s) allows you to use Regional
General Permit No. 198200030 when issued by the US Army Corps of Engineers (USACE). This letter
shall also act as your approved Authorization Certificate for impacts to the protected riparian buffers per
15A NCAC 213 .0243. In addition, you should obtain or otherwise comply with any other required
federal, state or local permits before you go ahead with your project including (but not limited to) Erosion
and Sediment Control and Duke Power regulations and permits. Also, this approval to proceed with
your proposed impacts or to conduct impacts to waters as depicted in your application shall expire
upon expiration of the 404 or CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change your
project, you must notify us and you may be required to send us 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.
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
Amount Approved (Units) Plan Location or Reference
Shoreline 376 (feet)
Waters 0.069 (acres)
Buffers 7,144 (square ft.)
401 Wetlands Certification Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.staie.nc.us/ncwetlands
No'rthCarolina
Naturally
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Greg Pollak
Page 2 of 2' '
December 3, 2004
2. Diffuse Flow
An additional condition is that all stormwater shall be directed as diffuse flow at non-erosive
velocities through the protected stream buffers and will not re-concentrate before discharging into
the stream as identified within 15A NCAC 2B .0243(5).
3. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is re uired to return the attached
certificate of completion to the 401/Wetlands Unit, North Carolinaivision 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. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification shall expire upon
expiration of the 404 or CAMA Permit.
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 Chapter 150B of
the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service 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 protection rule as described within 15A NCAC 213 .0243. If you
have any questions, please telephone John Dorney at 919-733-9646 or Bob Zarzecki at 919-733-9726.
AWK/bs
Enclosures: Certificate of Completion
GC 3373
Catawba Buffer Fact Sheet
Sincerely,
I r-1
Alan W. Klimek, P.E.
cc: Duke Power Lake Management, PO Box 1006, Charlotte, NC 28201-1006
USACE Asheville Regulatory Field Office
DWQ Mooresville Regional Office
File Copy
Central Files
Filename: 04-1717 Greg Pollak (Catawba) 401 CBR
?F, W ATFR Michael F. Easley, Governor
Q
?
? G
`
?- William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources

C3 Alan W. Klimek, P.E. Director
Division of Water Quality
December 3, 2004
Greg Pollak
7971 Tradewinds Drive
Sherrills Ford, NC 28673
Subject Property: 2780 & 2766 Camden Pointe Drive on Lake Norman
DWQ Project # 04-1717
Catawba County
Approval Of 401 Water Quality Certification And Authorization Certificate per the Catawba River
Buffer Protection Rules (15A NCAC 2B .0243) with Additional Conditions
Dear Mr. Pollak:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact approximately 0.069 acres of waters and 7,144 square feet (ft) of protected
riparian buffers for the purpose of installing rip rap to stabilize approximately 376 feet of shoreline, as
described within your application dated October 25, 2004. After reviewing your application, we have
decided that the impacts are covered by the N.C. Division of Water Quality (DWQ) General Water
Quality Certification Number(s) 3373 (GC3373). The Certification(s) allows you to use Regional
General Permit No. 198200030 when issued by the US Army Corps of Engineers (USACE). This letter
shall also act 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 go ahead with your project including (but not limited to) Erosion
and Sediment Control and Duke Power regulations and permits. Also, this approval to proceed with
your proposed impacts or to conduct impacts to waters as depicted in your application shall expire
upon expiration of the 404 or CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change your
project, you must notify us and you may be required to send us 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.
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
Amount Approved (Units) Plan Location or Reference
Shoreline 376 (feet)
Waters 0.069 (acres)
Buffers 7,144 (square ft.)
401 Wetlands Certification Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] /FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetiands
Nose Carolina
Ntmally
Greg Pollak
Page 2 of 2
December 3, 2004
2. Diffuse Flow
An additional condition is that all stormwater shall be directed as diffuse flow at non-erosive
velocities through the protected stream buffers and will not re-concentrate before discharging into
the stream as identified within 15A NCAC 2B .0243(5).
3. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
certificate of completion to the 401/Wetlands 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. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification shall expire upon
expiration of the 404 or CAMA Permit.
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 Chapter 150B of
the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service 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 protection rule as described within 15A NCAC 2B .0243. If you
have any questions, please telephone John Dorney at 919-733-9646 or Bob Zarzecki at 919-733-9726.
AWK/bs
Enclosures: Certificate of Completion
GC 3373
Catawba Buffer Fact Sheet
Sincerely,
't
` Ir
r Alan W. Klimek, P.E.
cc: Duke Power Lake Management, PO Box 1006, Charlotte, NC 28201-1006
USACE Asheville Regulatory Field Office
DWQ Mooresville Regional Office
File Copy
Central Files
Filename: 04-1717 Greg Pollak (Catawba) 401 CBR

November 4, 2004
To: Ms. Cyndi Karoly, Supervisor
401 Oversight Unit
NC Department of Water Quality
Parkview Bldg.
2321 Crabtree Blvd.
Raleigh, NC 27604
From: Greg Pollak
7971 Tradewinds Drive
Sherrills Ford, NC 28673
Ref: DWQ Project # 04-1717
Catawba County
Dear Ms. Karoly:
NOV 0 g 2004
DENR -, WATER QUALITY
WETLANIDS Ap STORMWATER BRANCH
On Monday, November 1, 2004 I received your letter via certified mail responding to my
application to put in place a shoreline retention system on Lake Norman consisting of RipRap.
Your certified letter requested additional information as follows:
1. You stated within your application that you intend to clear the first 18 feet of
Zone 1 of the protected buffer along 376 feet of shoreline. Can you minimize the
amount of buffer disturbance? Can the work occur from a barge to avoid this
impact?
Let me first address the second question: Yes, the work can be accomplished from a barge but
the cost for me is prohibitive.
Regarding the first question: Yes, the contractor performing this work can minimize the amount
of buffer disturbance by restricting access to the buffer zone by the equipment in a way that
approaches the shoreline in staging areas that will be no more than 8 feet deep into the buffer
zone and just wide enough to maneuver the equipment. This method was suggested by Alan
Johnson of the Mooresville Regional Office when I talked with him on Wednesday, November 3,
2004. 1 also talked this over with Bob Zarzecki, of your office, on Thursday, November 04, 2004
and he is in agreement with this strategy.
Every effort will be made to minimize damage to the zone 1 area.
I appreciate your consideration of my application.
Very truly yours,
V4'
Greg P lak
Note: a copy of your October 28, 2004 letter is enclosed.
cc: Mr. Alan Johnson
W A r?9p Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
O 'C Alan W. Klimek, P.E. Director
Division of Water Quality
October 28, 2004
DWQ Project # 04-1717
Catawba County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Greg Pollak
7971 Tradewinds Drive
Sherrills Ford, NC 28673
Subject Property: 2780 & 2766 Camden Pointe Drive
REQUEST FOR MORE INFORMATION
Dear Mr. Pollak:
On October 25, 2004, the Division of Water Quality (DWQ) received your application
dated October 25 to impact 0.069 acres of waters, 7,144 square feet of buffers and 376 feet
of s shoreline to install the proposed rip rap. The DWQ has determined that your
application was incomplete and/or provided inaccurate information as discussed below.
The DWQ will require additional information in order to process your application to
impact protected wetlands and/or streams on the subject property. Therefore, unless we
receive the additional information requested below, we will have to move toward denial of
your application as required by 15A NCAC 2H.0506 and will place this project on hold as
incomplete until we receive this additional information. Please provide the following
information so that we may continue to review your project.
Additional Information Requested:
1. You stated within your application that you intend to clear the first 18 feet of
Zone 1 of the protected buffer along 376 feet of shoreline. Can you minimize the
amount of buffer disturbance? Can the work occur from a barge to avoid this
impact?
Please respond within three weeks of the date of this letter by sending this information to
me in writing and Alan Johnson of the DWQ Mooresville Regional Office. If we do not
hear from you within three weeks, we will assume that you no longer want to pursue this
project and we will consider the project as withdrawn.
This letter only addresses the application review and does not authorize any impacts to
wetlands, waters or protected buffers. Please be aware that any impacts requested within
401 OversighUExpress Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands
NorthCarolina
Naturally
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper
Greg Pollak '
Page 2 of 2
October 28, 2004
your application are not authorized (at this time) by the DWQ. Please call Bob Zarzecki
or Ms. Cyndi Karoly at 919-733-1786 if you have any questions regarding or would like
to set up a meeting to discuss this matter.
Sincerely,
Cyndi Karoly, Supervisor
401 Oversight Unit
CBK/bs
cc: Alan Johnson, DWQ Mooresville Regional Office
USACE Asheville Regulatory Field Office
File Copy
Central Files
Filename: 04-1717 Greg Pollak (Catawba) On Hold
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
October 28, 2004
DWQ Project # 04-1717
Catawba County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Greg Pollak
7971 Tradewinds Drive
Sherrills Ford, NC 28673
Subject Property: 2780 & 2766 Camden Pointe Drive
REQUEST FOR MORE INFORMATION
Dear Mr. Pollak:
On October 25, 2004, the Division of Water Quality QI WQ) received your application
dated October 25 to impact 0.069 acres of waters, 7,144 square feet of buffers and 376 feet
of s shoreline to install the proposed rip rap. The DWQ ?as determined that your
application was incomplete and/or provided inaccurate information as discussed below.
The DWQ will require additional information in order to process your application to
impact protected wetlands and/or streams on the subject property. Therefore, unless we
receive the additional information requested below, we will have to move toward denial of
your application as required by 15A NCAC 211.0506 and will place this project on hold as
incomplete until we receive this additional information. Please provide the following
information so that we may continue to review your project.
Additional Information Requested:
1. You stated within your application that you intend to clear the first 18 feet of
Zone 1 of the protected buffer along 376 feet of shoreline. Can you minimize the
amount of buffer disturbance? Can the work occur from a barge to avoid this
impact?
Please respond within three weeks of the date of this letter by sending this information to
me in writing and Alan Johnson of the DWQ Mooresville Regional Office: If we do not
hear from you within three weeks, we will assume that you no longer want to pursue this
project and we will consider the project as withdrawn.
This letter only addresses the application review and does not authorize any impacts to
wetlands, waters or protected buffers. Please be aware that any impacts requested within
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699.1650,
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] /FAX [phone]/ Internet: htto://h2o.enr.state.nc.us/ncwetlands
6 Carolina
?tutally
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper
Greg Pollak
Page 2 of 2
October 28, 2004
your application are not authorized (at this time) by the DWQ. Please call Bob Zarzecki
or Ms. Cyndi Karoly at 919-733-1786 if you have any questions regarding or would like
to set up a meeting to discuss this matter.
Sincerely,
Cyndi Karoly, Supervisor
401 Oversight Unit
CBKlbs
cc: Alan Johnson, DWQ Mooresville Regional Office
USACE Asheville Regulatory Field Office
File Copy
Central Files
Filename: 04.1717 Greg Pollak (Catawba) On Hold
OTPY ISSUED
TILt U 401 ?
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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 Permit
GP30. This Application cannot be used for wetland or stream impacts. Please
provide seven (7) copies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $200.00 for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of-ANLater Quality Wetlands Unit
1660 A f*il SeMee C-en
Raleigh, NG 2;699 1650--
I.
Applicant Information
11
i'
92,
2.
Owner/Applicant Information
Name: i E
Mailing Address:
Telephone Number: 70q-
E-mail Address: , C,7-,7 T'
041717
Al C _JIv -,-i, Qcm, ?

Fax Number: 70e-1 3?.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:
Fax Number:
II. Project Information
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.
1. Location 1
County.- CI 7-,Iw 8,+ Nearest Town: S?tr ei114 ,t/&
Subdivision name or site address (include phase/lot number): & 6,w
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity / map is included): ..z-77 N t?dte r/ f
T) 4,e 7,Ar/lam Lt ©>., , Ph' Art*e
IuT, of 4J .? (/ ?aS.- r .wc['en t N7? Irr? .
2. Describe the existing land use or condition of the site at the time of this
application: ??/ s-7 .. q (6Gr 2cad
3. Property size (acres): 02 Lo 3 r #? N ?3 ?c Lo7f ,, p 2 ¢ e
4. Nearest body of water (stream/river/sound/ocean/lake): 1-4ke /jfc p,N,,
5. Describe the purpose of the proposed
6. List the type of equipment to be used. to construct the project: -,Y?,pvl7?.e li-,?O
7. Amount of impact (including all excavation, backfill, rip rap, retaining
etc.) below the normal pool lake level in square feet or acres: iP4;2 8. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the normal pool lake level and 50 feet 1 nd-war in
square feet
daa
`?or7acres: ?j
Tr. 7- J _,76
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance):
/''A y'
Applicant7Agent?grnature ate-
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
W. I
?U
Please approximately sketch the foltowing information on this plan
(please provide dimensions for each Item, such as 10 ft x 100 ft):
1) All proposed vegetation dearing (provide dimensions).
2) Location of rip rap or fill to be placed above the FuN Pond elevation
3) Location of rip rap or fill to be placed below the Fuft Pond elevation
4) The location of any proposed structures such as buildings, retaining
walls, docks, etc.
5) The location of any excavation or dredging below the Full Pond
elevation.
6) Location of construction access corridors.
?e
? 37(,
?? A6 F,
/F 3,Z, FT
durei wa
tttxatt
C
below full
pand i ft x = ft
sieve fill
MPL
Please approximately sketch the following information on this plan
(Please provide d"unensions for each Item, such as 10 ft. x 100 ft):
1) All proposed vegetation clearing (provide dimensions)
.2j Location of rip rap or fill to be placed above the Full Pond elevation
3) Location of rip rap or fill to be placed below the Full Pond elevation
4) The location of any proposed structures such as buildings, retaining
walls, dons, etc.
5) The location of any excavation or dredging below the Full Pond
elevation.
6) Location of construction access corridors. -
LOT 2
_?•?_ ?p J//C`lf;?j(?? LOT I ?Ou3
nos.
t.,a?... fat-
aua- •r of
h Q•* iZC 1 P/? MA
7 37
I t.bv S aa61Au« 1.07 Aor"
0.96 Aa'«
0.74 Aa 35
1.01 /Kr`a
/ 0.73 A--
0.66
r..
o.M a6a FifTURK DaYgE OPM
aL1 ??.. /
10 a9s r J
I an Amw /
11 33
0-a2 ?.. tm A-
?o ,s 1
12\'\
ae9 0.65 A- .) \
1 Aaw ? ? / /
l ?
13
aat Aorr. I
I 23 17
1.00 \ _ 1 31 Lx 1
r ?
1 °O0 "°" ` LAKA" 1
! 1b ? ' /1/ORMAN /
IA2
>RMAN
11 1 a
r i ?7ro? ?`\
20 29
aa9 Aae? t•z7 Mw
J r ? ck, uc? rw oar,a,?
278o
p? Aorw
I ?-798i I >?
'l?IM'bE? 22 J2 7?
a64 A... a 7
23
\ 1.17 An
28
oa3 na..
4
NORMAN 24 !
L.43 Amw .
- _ 1 1.36 A«wl
PUBUCATION OR REUSE OF THESE ORAW,NOS OR ANY OETA1LS WITHIN MUST E 7? THE TTEN/CON NT 0 F O.K. BARR
Q 8 . • Acred 1.
1.46
1.23 : ?Acre?s. o
.-28.
0082 Acres i
0A -
.? 27
-Acres . 7 'Acrd
,t
9
ki
I A
The following is an abbreviated application form for those applying for a 401 Water er
o /^
Qualitr-• Certification to impact FERC (Federal Energy Regulatory Commission) ;D
regulated lake shore or bottom under the U.S. Army Corps of Engineers Permit
GP30. This Application cannot be used for wetland or stream impacts. Please ?'`,
provide seven (7) copies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $200.00 for c?
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to lake bottom ° r
of greater or equal to i acre. ?Lluf
c
Applications should be sent to:
Okision of Water Quality 3A?ffands
1660 At-ail Se-: __ Gen nAeig NG 27-699 1650-
I. Applicant Information
2.
1. Owner/Applicant Information

W Ci AV Z3Lc+1 Q?(.?R?P.E' Ut'(,c p?t 7? S
i
41.4 lG
041717
Mailing Address: 7'i 7 / T?•t v a s &C -
Telephone Number: '70 /-38 2 - S `? Fax Number: 7ae-1-3,?_2 -
E-mail Address: C7 J' POLLii K n
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:
Fax Number:
IL Project Information
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.
1. Location
County.- C/7 7-4w e,+ Nearest Town: S?
Subdivision name or site address (include phase/lot number): o17?v a71?? CAw pM i?,P?
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if /an adequate vicinity map is included): 1- J7{7 N v-fv/<, , f 86 . ,LP?f o,eJ
/.t)e I r Q 7,o I IA c?N sQP /! .GC3K Ai 7 - S ifl (P
0 IV Y
i 1 e .e .2 - S,c-ri `tS. ? A,r-.cPeyc
(S r c HA.O? 1 ? fl ? .
2. Describe the existing land use or condition of the site at the time of this
application: ?,r. s fw % s ti? 6 /2-a Cry dCaj ,
I Property size (acres): oZ Jas 23 -ZP - ?z c
4. Nearest body of water (stream/river/sound/oce!!an/lake): ,?ke 41 o
5. Describe the purpose of the proposed work. I?-t '. i.,1)
-Of
b. List the type of equipment to be used to construct the project: E, of .r .? mod'
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres: iPi,?2
?/a.P.cil g hke 7 B )f,r ?6P7'?rie , / ?V 2(,
J
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the normal pool lake level and 50 feet land- arin
square feet or acres: ,P?rf% C Sa
X 376 ,,F 'I Pw? c
z;Q:?tTA UjI e ,o
If 764
3
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance ).__L/
?orlsi o
-?-
Applican gent's Signature
ate
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
,
46C
&0 1'?
Please approximately sketch the fottowing information on this plan
(please provide dimensions for each Item, such as 10 ft. x 100 ft):
1) All proposed vegetation clearing (provide dimensions).
2) Location of rip rap or fill to be placed above the Fug Pond elevation
3) Location of rip rap or fill to be placed below the Full Pond elevation
4) The location of any proposed structures such as buildings, retaining
wails, docks, etc.
5) The location of any excavation or dredging below the Full Pond
elevation.
6) Location of construction access corridors.
eL F,-,!(P?J
f?37&.
F1(
! ?l 3 F

deamd am
IttxMIt
l below full---
Pond i ft X W ft
ehve ful(
peftd
EA AMPL
Please approximately sketch the following information on this plan
(please provide dimensions for each item, such as 10 fL x 10o ft):
1) All proposed vegetation deadnq (provide dimensions)
.2) Location of rip rap or fill to be placed above the Full Pond elevation
3) Location of rip rap or fill to be placed below the Full Pond elevation
4) The location of any proposed structures such as buildings, retaining
walls, docks, etc.
5) The location of any excavation or edging below the Full Pond
elevation.
6) Location of construction access corridors.
LOT2
i
LOT I
a a? e- .r a.
I t.ao Aar. o ea1Aa.. 37
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LOI /KY`«
0.66
an.. 0199 434
n
1 )
» 33
OA2 A- , tAS A-
l -
1 2\-\ 3O 0.65 A-« a / / 1 \
ac9 Aar.
} a33?Aar. ? \
u913?
I 7 ?? 17 R I \ 1
I 1 / OAS Aar. 1 t
1.00
101
1.012 A?
/ 1.10 Aar.
i°K? 1I 1o t
i"",4Iv
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0189 A- iS] Aa r?
l \ 4.. u+cTrp"L y.o arm n
21 CLSI
p29 A«w
?ofs lor
22
0184 Am..
2,3
26
043 A- \
a
/v4cpm 14 IV 24 I
L,3 A- 25. ( J
PUOUCA,710N OR REUSE OF TIiESE Oft AW1NOS OR ANY OETIJLS WS7TIIN MUST E YY11Y? THE 7-mµ/CON NT OF D.K. OARR
L -?
J
! f OU
Q.B? . A?crej,1
? _ ors
f?f
O\N
.23
'Acres o
v,
'28.
0.82 Acres
acre
27'
,.?crc
Acres 0. 7.5
{(.
V
DWQ# QLA ' 1-41-4
Plan Detail Incomplete
,_ 2 Who Reviewed:
Date 16 ?J- `
? Please provide a location map for the project.
? Please show all stream impacts including all fill slopes, dissipaters, and bank stabilization on the site plan.
? Please show all wetland impacts including fill slopes.on the site plan.
? Please indicate all buffer impacts on the site plan.
? Please indicate proposed lot layout as overlays on the site plan.
? Please indicate the location of the protected buffers as overlays on the site plan.
? Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the site plan.
-? Please provide cross section details showing the provisions for aquatic life passage.
? Please locate any planned sewer lines on the site plan.
? Please provide the location of any proposed stormwater.management practices as required by GC
? Please provide detail for the stormwater management practices as required by GC
? Please specify the percent of project imperviousness area based on the estimated built-out conditions.
? Please indicate all stormwater outfalls on the site plan. \ .
? Please indicate the diffuse flow provision measures on the site plan.
? Please indicate whether or not the proposed impacts already been conducted!
Avoidance and/or Minimization Not Provided +
? The labeled as on the plans does not appear to be necessary. Please eliminate the or provide additional
information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the impacts to the
Please revise the plans to avoid the impacts.
? This Office believes that the labeled on the plans as can be moved or reconfigured to minimize the impacts to the
Please revise the plans to minimise the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
Please revise the plans and provide calculations to show that diffuse flow will be achieved through the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer then it may be necessary to provide stormwater management
practices that remove nutrients before the stormwater can be discharged through the buffer.
Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
provide $ . This additional fee must be received before your application can be reviewed.
? Please complete Section(s) on the application.
? Please provide a signed copy of the application.
? Please provide
Mitigation
copies of the application, copies of the site plans and other supporting information.
? of compensatory mitigation is required for this project. -Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 2H .0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project. A
ou Svr' l..lttti ?(Ovf ,1t 1t f4v -tioL) tK ? ? C?ec,/r+
:p_ I U 3 Ttp ?I &t 5k\omA -e . LCI!/? -4ou Nt4lniwuZe 1
f t,?y?Y k (3 s-GxJ t` brrMn 0. bc'. t
o sn. ?- err, ???-?.c's- ?31N r?oewn Ct " ? 4'^ e'ree? ? ? .- -- :n._ ? (` 7