20040801 Ver 1_401 Application_20070322

gyp= 11 ~- boy 9 ga I
The following is an abbreviated application form for those applying fora 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 Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
I. Applicant Information
1. Owner/Applicant Information
Name: ~ow~ is ~•p
Mailing Address: ~7'f
Q~c~~od~ d
MAR 2 2. Z~~~
DENR - WATER QUALITY
y~ETt ANDS AND STQRMINATER BRHNCM
A
Telephone Number: 70~ -5~75~ - 4/3Z Fal Number:
E-mail Address: LcIiF~TtaE 4/~cJ~H-~TMAi~.form
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- At~iliatiop=
Mailing Address:
Telephone Number:
E-mail Address:
Fat Number:
II. Project Information
Attach a vicini~ap clearly showing the location of the property with respect to /
local landmarks such as towns, rivers, and roads. Also provide a detailed situ
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 ~ / f
Coiuit~ : ~~A~ ly Nearest To~~n: /SOY ~DOa
Subdi~-isiou name or site address (include phase/lot number): / ~~3 ~! ftA~+~ae.cs F~ewti,
Directions to site please include road numbers, landmazks, etc. (This is not
necessar,- if a<i adequate ~-icinit< map is included): ~.ro.+~. ~o.rwood } l~vc~u~.,N Move
1?~ ~ 12w.~cla.,l~~ ~_Iku.YC. k ~ (~. ~2.s ti ~- o N
iCA~~d.~,L(sCk,wrc_L. L.Eir~ o,a ~'4ND_~Al~~~e~c~L~_. 0~ 7/wi/QS o•~
~L ~. -~ t-
2. Describe the existing land use or condition of the site at the time of this
application: ,~CstOEw.--~~:~.I
3. Propem~ size (acres): , fQS~
~. Nearest body of eater (stream/ri~~er/soluid/oceai~/lake): I.~~~p~r~
~. Describe the purpose of the proCCposed work: /~ eDu.; r tt~t us ~. y~a.t '17 wrrfaa ~
1 i.-!~ ~ NG J CAL LG7a.t I
G. List the t` pe of equipment to be used to construct the project: ~ae~e. ~o~
/-~rQN D -~Z, o ~ 5
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) belo« the normal pool lake le~-el in square feet or acres: A~~ ~-e x Z5/o s
'~ t / ~ - ~ ~ ~ ~ -I•.re ~t a ~ S r+a, w ate! I C Q ~ P IZ AP ~
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-ward in
square feet or acres: f~~ ~ x. ,~~sQ ~-l: l,~ ~ . ,~, Q Sew e.Ja,..t [ .
b. Please describe vegetation above the normal pool lake level and 50 feet land- I
~~ and to be impacted (number of trees for instance): Gce ti o Sc a0 ~ iy~ Q drG~ L~u.~a) w.j
BIZ, /o
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

V ~ o-~ - o gel
Lake 4Fu11 Pond
Full Pond
Shoreline
i
.Z
1
0
`.~
J
~~~ R~, ~
.3 J~ /~ELoov a/IPOND
S ~X~S'4 be,.~ .~wll
P~~a
/. 21+~ew.i a e~r~ ~-M 3.~..;~D S.~ a. wa.t I
/~~pox 5'w~~x rs'LoN9
L, ~-,'~~ w,+~ s•~o~,~ ~ 2,p R.P.
3, Cov~v F,~,~ft; G~,e~D•~ri--
4. Qd~ 3 ~x a~o-F v''~ rw~ - ~
0
~ ~
rQ ~'
Please approximately sketch the following information on this plan
(please provide dimensions fr~r each item, such as 10 ft. x 100 ft):
1) All proposed vegetation clearing (provide dimensions
7) Location of rip rap or fill to be placed above the FuU Pond elevation
3) Location of rip rap ar fill to be placed below the Full Pond elevation
4) The location of any proposed structures such as buildings, retaining
walls, docks, etc.
3) The location of any excavation or dredging below the Full Pond
eleVatlori.
6) Location of construction access corridors.

rvta~ ui i i~+?~+ r~auuairs rrrry Rai ivutwvuu, ivy vy ivta~~,,uc~r
Sorry! When printing directly from the browser your map may be incorrectly cropped. To print the
entire map, try clicking the "Printer-Friendly" link at the top of your results page.
MAPQUEST ~a ov-Devi
~ 17434 Randalls Ferry Rd
Norwood, NC 28128-7460, US
Sorry! When printing directly from the browser your map may be incorrectly cropped. To print the
~°°' entire map, try clicking the "Printer-Friendly" link at the top of your results page.
52
Porter
,~s
e
7il~er y
24' 27
73
ra`c r vi ~
52
Nnrwoad
Moun! Gilead
w Nydro ~~~48UOrft
4liae'4~tiE'ST 52 ~~2CG7G~~r•C;~ •;1:r~. '~~D~~~7!vnv3FC)
All_ri~hts reserved_Use. Su~ect to License/Copyright
This map is informational only. No representation is made or warranty given as to its tontent. User assumes all risk of use. MapQuest and
its suppliers assume no responsibility for any loss or delay resulting from such use.
http ;'ww~~.mapquest.cone/mapsimap adp?searchtype=address&country=ClSRaddtohistory=Rsear 3/?0%2007

- ,
_
;
-

_,

~
, ,
,;
1 ~ t:
~'~' ~ r
f
-

*.
~
r,.

.
, -
. " ~ , i
~
'
~ ~
i
~ ,
~1
'
~"-.

• ~
~
~~391 j
.-
1~
~ ~ ~ ~~
. ,
.
~
~
.l , ~ ' ~ 399

.
r. -•-
.
` ~

(

, 111

1

,~ ;
,

~

_ t

~.
~~ ~

;
- _

•
~

•..
. _
.
1 i
~
_ '
s~i04 r 1 ~ i
' ~ ~ ~ - ~

~
~ ' l

`
~ ~., r ~ ~ - J78 1~

.
~'
~ ~
,- 4~4 ( 1
' 8t+t .
~
- ~ ~~;
I I

~~
~ Y
.~~
, f -
,~, 1
. t
Q
_
j
~ ,

,,
_.

.
00
'

~
~
~
.~ ,
~
r
.,

.,
~ 378'
_... .. r.
I .
t
1 3903 `~ ~ ~_ ~O~ - ~ ~ ~ ~ arg
E ~
,. ,.

~•.
- ~ -

- ~, ~ •s~

.
~,_ ~. __ ,

• - ..

'~ ;
/~
~
_
- __
`
• ~-
.:

:.

.
Ch
.. O?'
..
/

.
,..
~ ~, , n~ :
_~ ._
~
~ '

~~
-

~
_. ~
~
BM
~ ~~ ~ ~ ~'
i' ~
'i ~ ~
3 3 ,_~
~ f ~
~
. •.

.
_
~,
~
,
t~

y
.,
_

- ~ ..
''

_
. ~
• r - _ _
,~ -
i _.~
_ r

-• _
--"t

~
~ ,

~
~
_,
` ~ ". ,
~ ~
550000 `~~ ~
, 3ze
_ _
8M
282 ~ ~_ _

'
__
` ~ .

I
ij
1 a>s ~

^',
( 9t3 ~
..
FEET
_ ,. ~
,~
_.
` -
'
y
~ ,_ ~ ~
_ ~ f.~~ -

~ .., t
_-
1 -_
~ ~, ~ ,
~
;
i i
,

-~
- ~
.
r
_ ___
~ ~ ~,,
~ .
.,,
~~
,, , t

~
_ _. _
s r `/-
~
;.:
_

.
~ --'~~ - -

Emerald
~
: ~ ..
35`15'.--.~:_~- `~' ••.~.._ .

-
_-•.,..
~~~
~ .-., ` '~ l\
hor ,I
cJ e5 ~ r
- - 167000
80° 07' 30' 580 ,_~
~ sg~ t T .~. ,, ti~ -_-. _ ~-;
"~
~

Produced by the U.S. Geological Surve '83 .
----~~ _
5 s84
58
y
Revised by the U.S. Forest Service 5
SCALE 1:24 000
Areas otnside the National Forest
System lands may not have been revised. MN
GN •
F

Convo! by USGS. NOS/NOAA and North Carolina Geodetk Survey ~
~
1 ~-.,_~.~~~~,5~- _~_~
-
Compiled from aerial hot p

P ogra hs taken 1977. Revised (tom aerial
photographs taken 19A3
P

' 0032'
0
~,~
10^~ ~ ~~su~ ~=n ~_ _- 3~ ~ _ `nG9 500 EOGO
.
artial field check by U.S. Forest Service 1994. 30• ' 9 MiI,S
7 t'E f
North American Datum of 1927 (NAD 27). projection and 14 000-loo[ ticks:
North Carolina courllnate s
ste
L
b 733 MILS ' K t
rr--- -- ~~__~~_ _ _ -~_fE `E RS_
y
m (
am
ert conformal conic). Blue
I000.meter Universal Transverse M
f ! ~f i,_pr ,~,;,
ercator tides, zone 17,
North American Datum o{ 1983 (.NAD 83) is shoum by dashed comer licks.
The values of the shift between NAD 27
d trrM GRID AtVD 1995 DfAGTY1TIC npr;t7t CONTOUR INTERNAT. 10 FEET
an
NAD 83 for 7.5-minute
intersections are obtainable from National Geodetic Survey NADCON softtsare. DECLINATiOrv AT CF1vvTFR OF SHEET NATIONAL GEODETIC VERTICAL DATUM d
TO t:OiWVF.RT FEET TO ME11=EtS MULTIPt
Y BY 0
Nan-National Forest System lands within the Nationat Forest .
_ Inhotdings may exLvt in other Natiotu! or State reservations.
This man la mr :. Iono1 ~~.../ ...... -- . ..