20070634 Ver 1_Shoreline Stabilization_20070410

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 anon-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 bo>~om 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 2 p 0 7 0 6 3 ~'
., ,
I. Applicant Information E; ~ - 1. I ~ ='-
1. Owner/Applicant Information
Name: Robert VanGraafeiland for Lake Royale Property Owners Association
Mailing Address: PO Bog 265, Bunn, NC 27508
Telephone Number: 252-478-4121
Fax Number: 252-478-3599
E-mail Address: rwv;:(a7lakeroyalepoa.ora
2. Agent/Consultant 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: Robert VanGraafeiland
Company Affiliation: General Manager /Agent
Mailing Address: PO Bog 265, Bunn, NC 27508 ~ ~~ ~ ~ ~~, ~y ',~j
Tele hone Number: 252-478-4121 ice'"
p
Fax Number: 252-478-3599 ~I'R 1 ©2007
E-mail Address: rwv;;(a,lakeroyalepoa.ora
?)EiNR - WATER Qt1ALITY
1'I,P~d0.S ~~ STnRa1~1~,A1 ~R 9RA~1CN
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. Both the vicinity map and site plan must
include a scale and north arrow. The specific footprints of all buildings, impervious surfaces, or other
facilities must be included. If possible, the maps and plans should include the appropriate USGS
Topographic Quad Map and NRCS Soil Survey with the property boundaries outlined. Plan drawings,
or other maps may be included at the applicant's discretion, so long as the property is clearly defined.
For administrative and distribution purposes, the USACE requires information to be submitted on sheets
no larger than 11 by 17-inch format; however, DWQ may accept paperwork of any size. DWQ prefers
full-size construction drawings rather than a sequential sheet version of the full-size plans. If full-size
plans are reduced to a small scale such that the final version is illegible, the applicant will be informed
that the project has been placed on hold until decipherable maps are provided.
1. Location
County: Franklin Nearest Town: Bunn, NC
Subdivision name (include phase/lot number): Lake Royale Subdivision, lot 151
Directions to site (include road numbers/names, landmarks, etc.):
Page 5 of 6

2. Describe the existing conditions on the site and general land use in the vicinity of the project at the time
of this application: The area is a community park and also services a large docking area on Lake
Royale, the shoreline has been eroding for sometime.
3. Property size (acres): 2.5
4. Name of nearest named receiving body of water(stream/river/lake): Lake Royale, Cypress Creek
5. Describe the purpose of the proposed work: Stabilize the shoreline and prevent further erosion
6. List the type of equipment to be used to construct the project: Backhoe and handheld equipment
(sledge hammer, shovels, rakes...)
7. Type and amount of impact (including all back fill, excavation, riprap, retaining walls, other fill, etc.)
below the normal pool lake level in square feet or acres, and distance from shoreline:
Back Fill - 250' g 1.5' (1' deep) to level out land behind the seawall for safety - 375sgft.
Retaining Wall - 250' z 1' to be installed on the average of 1' from the eroding shore line -
250sgft.
8. a. Type and amount of impact (including all clearing, back fill, excavation, riprap, retaining walls, other
fill, etc.) above the normal pool lake level and 50 feet land-ward in square feet or acres:
Back Fill - 250' g 1.5' (2' tall) to level out land behind the seawall for safety - 375sgft.
Retaining Wall - 250' z 2' to be installed on the average of 1' from the eroding shore line -
500sgft.
b. Please describe the vegetation above the normal pool lake level and 50 feet land-ward to be
impacted (number of trees for instance): The current vegetation is grass that shall be driven on
by the back hoe and the entire area shall be stabilized with seed and straws.
r
vApp'`icant/Agent's Signature ~~ Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 6 of 6

STATE OF NORTH CAROLINA
Department of the Secretary of State
STATEMENT OF CHANGE OF REGISTERED
OFFICE AND/OR REGISTERED AGENT
Pursuant to §55-5-02, §SSA-5-02, §55-15-08, and §SSA-IS-08 of the General Statutes of North Carolina, the undersigned
corporation submits the following for the purpose of changing its registered office and/or registered agent in the State of North
Carolina.
INFORMATION CLf RRETI`TLY QI~I FILE
The name of the corporation is: 0. ~o e~.l e.. ~ ~ et-~ d~Y~l°-(~S ~ SOC-1Cn`t'
The street address and county of the corporation's registered office can-ently on file is:
Number and Street:
{`
County: >~CA h ~'t r1
City, State, Zip Code: ~br,•`~S~ A{' ~ ~ Z7S~
The mailin address if different from the street ddress of the registerec
The name of the current registered agent is:
,~~~e
1. The street address and county of the new registered office of the corporation is: ~
(complete this item only if the address of the registered office is being changed) (J~,r„~ ~,
Number and Street:
City, State, Zip Code:
County:
2. The mailing address if different from the street address of the new registered office is:
(complete this item only if the address of the registered office is being changed) ~~ti+M~,
3. The name of the new registered agent and the new agent's consent to appointment appears below:
(''complete this item only/if the na(m~e of the registered agent is bein - ~
i~n~ e f~ yC~h of e~~-'t-e ~\ c~~ '~ - P/' c~.n e
Type or Print Name of New Agent * gnature & Title
4. The address of the corporation's registered office and the address of the business office of its registered agent, as changed,
will be identical.
5. This statement wiGl! be effective upon filing, unless a date and/or time is specified: 1 `~ f~
This is the `day of c 20~. ~o I 1 1-C ,..v~C,
oration Name
~~
office currently on file is:
Signature
Type or Print Name and Title
Notes: 1. Filing fee is $5.00. This document and one exact or conformed copy must be filed with the Secretary of State.
Revised January 2000 Form BN-06
CORPORATIONS DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622

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