20051863 Ver 1__20050104

~,Ep- H-'200S 85: 13 FROi'1: Dl,JQ-!,jETLAt.jDS ~H '373368'33

TO:'318284953CiSO

P; 1'5

The following is an abbre,iated application form lor those applying for u 401 Water
Quality Ccrtific~tion to impact FERC (Fcd~m) Encfro: Regulatory ComlJJissi()~)
regulated lake :shore or bottom under the U.S. Army Corps of Engineers Penmt
GP30. This Application cannot be used for wetland or stream impacts. Please
provide seven (J) copies of this application and supporting information as well :1$ :l
non-refundable application fee to the Division of 'V~ter Quality of ~for
impacts of to laJ<e bottom of less than 1 acre and 5475.00 for impacts to lake bottom
of greater or equal to 1. acre.

Division of Water Quality Wetl.mus Unit
1650 Mail Service Center
Raleigh, NC 27699-1650

~rn@rnn\Ylrn~

OCT 4 - 2005

Applications should be sent to:

DEW'. WATER QUALITY
WEl1J.ND3 N;O STOi\lI.WATf.lll'.iWiCH

1. Applicant Information

1. Owner/Applicant Infot!]lation ~.. I
Nam,e: '- ) tl-t1\~....s._J <--J.d,-e-r( :r-1
MailingA~ P.;l'S~N:~/J;,~~er ~')L.

Telephone Number: ~ & ~,:).):3 g l{ '(
E-mail Address:

Fax Nwnbcr:

_"(::>.:) ... LflJ I

2. Agent Infomution (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the ov...ncriapplicant,)
Name: f//~,.,,, c.. Cu." t-. C..
Company Aft11iation: ~ /0r'1.' <. C" ...-1.-.,..: Jr..' ,.
Mailing Address: . /+\-') l o..t...(c.hd 0".
.-1 I'C ~J ./",.J. L ','1 - -: (' (

Telephono N\.unbcr: ff)I{' .1-./> \;-. JO"'t- 0 . Fax Number:
E-mail Address: fr'.::Jr.nc- C<':A -I (!et;,r~~/. ,t" . ". J-

II. Project Information

Attach a vicinity map clcarly shOWIng the location of the property with re.~pect to
local landmarks such. as towns. rivers. and roads. AJs.o 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 sk.etch of

. . _~......_ ,_.'-., .._............... . -.......... ,-,., ,-,-, "-"-',"-"~I-" lr.

;:::'wl;'~l

:=Ep.. J.+2085 0S: 1'3 FRCif1: Dl-!I]-I..JETLHNDS '3197336893

TO: '318284953050

P:2/::.

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,

I. Location " f i j
County: C(l+rA f,-' ~ c. Nearest Town: 1-1 /c....~u;/...l I
Subdivision name or site address (include phase/lot number): C u P-h";l i AC) C ... V c-
Directions to site please include' road numbers, landmarks, etc, (This is not
necessary if an adequate vicinity map is included):

2. Des~rib~ the .~ting l~d use ~r ':Ondition of the site at ~tf t.ime, off this. /
applica.tlon: .J.l2...'..!. j", nt1 ei-lc::,'.f",~ J,u'YlL CHl +/..,' Iv LJ;J~ L{
,~.<'".....:-I / (t=c~/I"" S )

3. Property size (acres):

, J ~ !J (. v t?3

5, Describe the pll.rpose ofthe proposed work: . /..

L ,. L <- I--I,'e. ["x' i
S.f.c1~n!. 2.<- st~\.(:J,... <-

4. Nearest body of water (streamiriverlsouodloceanllake):

6. List the type of equipment to be used to construct the project: '(;-0 <.. L, L (.) <- / Stl,cI:;.-fc e-
. I

7. Amount of impact (including all excavation, bac1cfil1, rip op, retaining walls,
etc.) below the nonnal pool lake level in square feet or acres; ()

8. a, Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc,! above the nOFal pool lake level an~, 50 I fe~t w.nd.w~r;.:i in
square feet or acres, IJM")", w .,.. Iy I c;" ,I...,) "1/" { 'f.. ! co, ,\ t..u. d,...t,
t I

b. Please describe vegetation above the normal. pool lake level Md 50 feet land-
ward to be imp.acted (number of trees for instance): Cv<\ ');; ,). I TV~ <.:..

Date
authorization letter from the applicant is provided.)

SEP-14-2005 015: 13 FF:OM:WQ-WETLAt'!D5 91'37336893

TO: 918284953050

P:3'5

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Pleas.-e ~proxfm3tcly ~h the'~ rnform:lt:::n an this plan
(pInaoo Pro11d:~~nsJon~ for ea,ch ~m. $~ch as '10 ft. x 11)0 It):
1) AD proposasJ vegetation dc::ring (pm'rido ~nsitms)
.2) ~ca.tfM rJf rip IiI.P C!I' fill to bel plat:ed abow the Full Pond. clevm'DIl
3) LocatiQD of rip .-ap o:r fllllo be plm:ed belovr the Fu!I Pond elewidion
4) 1be loaltIon of r;ny ~~d ~~ $UCh as buitdlrnp. rebUlllng
~ docIts, cJ~. .
5) Tho loc:atfunof any uJWmratiOrt Qr ~dgill9 bdow the Full Pond
eley~on.
6) ~~on or ~cnstt1.lct!on a:Q.'CCGO contdaro-

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Catawba County, North Carolina"

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11lis map product was prqxzredfrom the Catallva COUIlty. NC, Geographic Information System.
Catalloa Caunty has made substall/ial efforts 10 ensure the accuracy of location and labeling information
contained on this map. Catawba County promotes and recommends the indepcndentl'Crijicati:m of allJl
data contained on this mtp product by the user. The County of Catalloa, its employees, agents and
personna disclaim, and shall not be held liablefor any and all damages,/oss.or liabilry, whether direct, indirect
or consequentul which arises or may arisefrom this map product or the use thereofby any person orenlity.

Selected Parcel Number: 3705-20-70-7604

1 inch equals 81 feet

Prepared for:

4956

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5993

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Wednesday, August 03, 2005 12:53 PM
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Cata..vba County IMS

Page 10f2

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This map product was prepared from the Catawba County. NC Geographic Information System. Catawba County has made
substantial etrorts to ensure the accuracy oflocation and labeling info=tion contained on this map. Catawba County promotes
and recommends the independent verification of any data contained on this map product by the user. The County of Catawba. its
cmplo)ces. agents. and personnel. disclaim, and shall not be held liable for any and all damages. loss or liability. whethcr direct,
indirect or consequential which arises or may arise from this map product or the use thereof by any person or entity.

Date & Time Stamp
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3:05:26 PM
EST
Scale: I . = 272 '

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