20100470 Ver 1_Application_20100616

201004,0
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 five (5) copies of this application and supporting
information as well as a non-refundable application fee to the Division of Water Quality of $240.00 ii?
for impacts 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
Raleigh, NC 27699-1650 IM A I T"N
1.
2
Applicant Information
Owner/Applicant Information

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JUN 16 701Q
V ENR • wATER OUP1ITY
\ WET.A?!US D 5r"?„o MR BRANFU
Name: ?/V I L ??/n ?!? '?R?/•Cj ?D?:?J/l ?l`
Mailing Address: ;3D L.?%I fc 5 /2n
Telephone Number: S4$ - ?9'7 - eP0 7g Fax Number:
E-mail Address: 5mnth _ q c k teD \1a
Name: ?1 o vl
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.)
Company Affiliation: N ?-
Mailing Address: hyGo
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Telephone Number: <',?!7• a. 7,y Fax Number:
E-mail Address:pD?/mil 1 odl_R??r,,t R?•1 . Lc,?,?
II. Project Information
"
Attach a vicinity map clearly showing the location
of tl?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: _ sa z /I Nearest Town: .?_,4JMan7_
Subdivision name or site address (include phase/lot number): / l 4r_?e )2.,,c' Sc,,6
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included):
2. Describe the existing land use or condition of the site at the time of this application:
3.
4.
5.
6.
7.
8.a.
List the type of equipment to be used to construct the project: !s?? --s?ce- 1-0 C-7Z-
Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: 8? class ",E," /Al A 4Ze
L° X ? K s?a ?:1C riD?lOl.?! 1) tic C, a urr?r_ &4,1c
Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above th enormal pool lake level and 50 feet land-ward in square feet nr ate, P?
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): J/N
Property size (acres): p,agbX . / / vC , j r/c- ___ v? )J
Nearest body of water (stream/river/sound/ocean/lake):
Describe the purpose of the proposed work: <-,n lx 1i7Zc 7-11e l- k
?Agenrs signature is valid only if an authorization letter from the applicant is provided.)
Page 1 of 1
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LEGEND
EIP- EXISTING IRON PIN
NIP- NEW IRON PIN
EP- EDGE OF PAVEMENT
R/W- RIGHT OF WAY
PB- PLAT BOOK
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APPROX. LOCATI
100YR FLOODPL
PER COUNTY GI!
-4 Cy
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G? L
LAKE WYLIIE
SITEPLAN OF:
LOT UCKER ROAD SUBDIVISION
SOUTH P INT TOWNSHIP, GASTON COUNTY, N.C.
THE PROPERTY OF BILL KASDON
SCALE 1 "= 40' FLOOD CERTIFICATION
THIS IS TO CERTIFY THAT THE SUBJECT PROPERTY IS
MAP BOOK 77 PAGE/ 38 LOCATED IN A SPECIAL FLOOD HAZARD AREA AS SHOWN ON
// MAPS PREPARED BY THE FEDERAL EMERGENCY MANAGEMENT
DEED BOOK 4487 PlXGE 2,350 AGENCY, FEDERAL INSURANCE ADMINISTRATION, DATED
3-2-09 3710359300K
TAX CODE: 21/8436 COMP. NO. 10185 HD3