20070557 Ver 1_Application_20070330

2070557
`1'he 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 ii%ater 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 i acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
V
BAR ~ D
2007
~ENR-WATER
~~SAIyDSTprER
~'AkCf{
I. Applicant Information
1. Owner/Applicant Information
Name: ~ e. L~.) ~ ~ ~ I~c7 ~7 L ~ nl
Mailing Address: ~-t ~ ®2 5 j,_.tani ~ s t~ii.~ t~.d
Telephone Number: +7~ 4 ~/'~ ~1 ~- 7 t~ ~7 3 Fax Number:
E-mail Address: ~_ c~~ v ~ C C. V Ta ~t E_ -~ j c!a . T/ ~ i
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: Fax Number:
E-mail Address:
II. Proaect Information
Attach a vicinity map clearly showing the location of the property with respect to
focal 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

vni~r nrnicct. Alen. sec the example below for euidance. Both the vicinity man and
_ _ _ ~ a m~ n r •> > •i •-
Site ~J12111 111USi l11GiUUG it Stii11GtUlU 11U1U1 difUW. 1110 lUVltJ1111tJ Ul [111 UU11Ull1~S,
impervious surfiaces. or other fiacilities must he included.
Location
~ouliiy: ~ (~1~,1 Ly i~earest i own: I~B,~ WOO ~
Subdivision name or site address (include nhasei lot numberl:5t~no~; 3 LArc~ 1_~,T + i o
Directions to site please include road numbers, landmarks, etc. (This is riot
necessary ifi~an adequate vicinity man is inciudedl: E-IbJY 2~4~z7 ~a T~ 'N~~A~I /~ovND -?~
LEFT 1n/J"O ~r7.ti11~Ai.L''S ~,i~~RC1-?,Lt=t=r©~1 l.Au~s >=-vD lZd, HdU~F A.
~N~ ~r Ca
2, Describe the existing land use or condition of the site at the time of this
application: N f-3 vE ,~N E'x ~s Tr~rc- C~~~c 2~"rc SSA ~,,/A tl W rrF{ 1•Ec ~c H ~ S~1M @
T~S...~ytL •1~a~ D LcVcLy /11RVr's /-I2% G+~i~Sffli+IG Dt/~fZ tJpcc. L-2~i~iCy
3. Property sire (acresi: f:. i (v 1-ICRi:
~. dearest body of water (streamlriver/soundioceaniiake
5. Describe the nur_nose of the proposed work: ~ i ~ ate; L ~ ri cW~ StA tia r~LL ~ r~ ~Ro tir a~ ~
~xiSi ~~.•[r L'~~.1~rzL•TG sCtawr~.Li.-'-Z~~-S;`nr~- TIC i-It:~~i•1r Tim Etir.-as~.-rar~
disc l~/~.f~ixc ~F 5~~: L F/~ra v A t2D .
6. List the type of equiprrtent to be nsecl to coristn?ct the pmie_.ct~ AF i cn ni~,,f WA1.~ 15 e~3i.r~~r
c~Si.yr f1A.Vh "7Ca Ls . FRON r ENU Leta a ~ ~2 i c a.~Cfe ~x ~. G-RRVt?C~ ~ i2 ~ P iZRP sN Ft1o~N~
7. Amount of impact (including all excavation, bacici"ill, rip ran, retaining walla.
etc.) below thetnormal pool lake level in square feet or acres: ~i~ F-zca/r~r~a~.; GR~r~~~ 3 ~T
,~cEf'' X f2`~T3A~~cF~tLi I?cAi7A~ 3'i~/Ff~~r; 7'sT' ~2-yc'N :iJ c~vv~ -
~~..c T/~ / nr i ~ C9 G.i l~ f.L
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, t, ~) ' ~V~yi ~ ~__ ~ _' ~ rn r_-` ~--- ~
t above the norillrll 1 lax.G level a31u .~v iLGi l~litt-tivart-1 iti
square feet or acres: nlr> h_t.ER,2iv~ . ~Di a r- ~s~~ ro .aac~ Fi t.L tieoa.e ~is8i2n
N~c~J .51=~~.~./.a~-_. L•~ ~ E~i.v y iN~ ®c1~ c~.r~r,~s~c~ ~ C~A~r~~ 7d r3E f~.cQC~.n BC rt,~~~ ~.v
~/ P ~1 !~P t~GAc' c0 irl L~2e~.v T' ~~ nr'E1eJ L~.~ A.Z. c. .
h. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (n ber of trees for instance):_ C7Rtass , ~d TRrr's FLcu~teS
~t.~,f ~ ~ ti~ ~t/~ ~ t7 t ~ s
-2`i- 2c~~
Applicant/Ag~t''s Signature ~ Late
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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.,rtj ~~. Mapped, edited, and published by the Geological Survey ~ 7 0 ~ 5 7 5'
~ Control by USGS, NOS/NOAH and North Carolina Geodetic Survey
~61~k,; Topography by photogrammetric methods from aerial photographs Mn_
takem 177. Field. checked 1978. Map edited 1981. cN
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systerr• (Lambert conformal conic)
lOaU-meter Universa# Transverse Mercator grid, zone I7 a9 MILS 0°33'
110 MILS
I927.North American`Qatum
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