20100893 Ver 1_Shoreline Stabilization_20101026

20100893
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
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: «?? `? ` Ll lr ?rf
Division of Water Quality 401 Oversight/Express Review Permitting Orr 1650 Mail Service Center DEW - WATER QUALITY
Raleigh, NC 27699-1650 CANDSAMDvTft,' rATERBRAMCtf
I. Applicant Information
Owner/Applicant Information
Name:
Mailing Address: ,
Telephone Number:
E-mail Address:
Fax Number:
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: Z'O".s???
Company Affiliation:
Mailing Address: 7?/
Telephone Number: Fax Number: --
E-mail Address:
H. 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. 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
County: Nearest Town:
Subdivision name or site address (include phase/lot number):
Directions to site please include road numbers, landmarks, etc. (This is not necessary an adequate
vicinity map is included): A''f%?
AX,
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres):
4. Nearest body of water (stream/river/sound/ocean/lake): 4& __0 5. Describe the purpose of the proposed work:
.?.
6. List the type of equipment to be used to construct the project: Cell
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: rx. ?? U ee
8:a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake leve and 50 feet land-ward in square feet or acre
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): Z l?

-L? .> ,wily S Syr
Applicant/A nt's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
?1?
SEP-6-2009 16:11 FROM:OWQ-WETLANDS 9197336893 TO:913366941900 P:5/5
J
IPleasa ,rmhnd*.. sketch -the fo§owkV i rdormabon an ;plan
Oftwe pr wlO Onenalone for e&M Rem, ouch as 10 ft. x 100 ft):
1) M AmR=W + ion claaring (provide dlmone me)
.2I 4vcglon of tip rap or fill to be placed above the FIB Pond •tevodlon
3) Locatlon of rip rap or fill to be placed below the Full find elevAlon
4) The locatlon of mW propmd O,-mv emh; " buIlding% retalning
WAF, docks. etc,
6) The location of mw excavation or "dging below tits ?Pond
elevat%on.
61 Locom of cots ruc,an sum corridora..
Custom Cuts Outdoor
Maintenance
Larry W. Butts
741 Rudd Ridge Road
Yanceyville, NC 27379
[phone]
AUTHORIZATION HAS BEEN GIVEN TO LARRY BUTTS (CUSTOM CUTS
OUTDOOR MAINTENANCE) TO ACQUIRE ALL REQUIRED PERMITTING TO
INSTALL EROSION STONE ALONG THE SHORELINE OF MY PROPERTY AT
HYCO LAKE. 267 CLEARWATER LANE SEMORA NC DOCK #1572.
10/14/10
LANDOWNER
RANDY BEZENSKI
S