20010082 Ver 2_Application_20101110

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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 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 $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
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DENR - WATER GUAUTY
WETLANDS AND STORMWATER BRANCH
L Applicant Information
1. Owner/Applicant Information
Name: 6FP, Cjv?cfer
Mailing Address: 1? 0. 0&)c oZ 666 Cats : e,- s , N'e oZ 87
Telephone Number- Ag- 7'V3-/$S6 Fax Number:
E-mail Address: c- under er: osi. n e7-
2. Agent Information (A signed and dated copy of the Agent Authorisation 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:
IL 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: ;T?a c ?-50A Nearest Town: Ca s ??'Pnf
Subdivision name or site address (include phase/lot number): 1117 N'e w
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included): r?? C Lx -e? !
IVC AfW y?<G7 !. B •`k `?!4.e ?C e r /?'e..y`4`it/'or?m tea/
1. 9l.`[AS Tn lN:???uw1 U.'?[AOo Q/LCP esr hr?Qltj ???0?
/+i`e w 7;` ,'11 i V ,n W"- w 7`O /! " v
2. Describe the existing land use or condition of the site at the time of this
application: YKega one l?'n e 4-t^'t e rd"'Lo tie( r/?r?'zv do?•1n ?-?,'
L°JC? ? ? iii ? - /?
3. Property size (acres): • 'Y 3 cz,c r-eS
4. Nearest body of water (stream/river/sound/ocean/lake): 4*4X 6-1e^ ,v1-11e
5. Describe the purpose of the pr? ed work: , e' i;r ec 7 beta lc ?
'7(-a iCrld .MrjP" ?1 6cr^t<?-. T'e^.-ua LOA •`
7'7V SYevs /A?cr^Wr-e.- d
I If
6. List the type of equipment to be used to construct the project: 445rc4 VJsr- 001 &fle
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres: 1,2 "X 3' -_ 36G 5 . -f;),
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: t,2-2 X S = Gl0 s9 )CY-
b. Please describe vegetation above the normal pool lake level and 50 feet lan -
ward to be impacted (number of trees for instance): G.-iess ?a ? 'm
14 7 f.
j /..2 l?
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all, C6.111 -
61
Applicant/Agent's Signature / Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Lake (Full Pond)
Full Fond
Shoreline
rdr.-
3r below (,t1mt ?
F/. R-10 _S7 7,464w t
Please approximately sketch the following information on this plan
(please provide dimensions for each item, such as 10 fL x 100 ft):
1) AM proposed vegetation clearing iprovide dimensions)
2) 1_ocation of rip rap or fill to be placed above the Full Pond elevation
3) Location of rip rap or fill to be placed below. the Full Pond elevation
40 The location of any proposed structures such as buildings, retaining
walls, docks. etc_
5) The location of any excavation or dridging below the run Pond
elevation.
6) Location of construction access corridors.
6_? dre-
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I MILE
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TFNNESSEE?
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Q;!AC,RANGLE LOCATION
37902
(NA 176-NW) J ?Q
ROAD CLASSIFICATION IVt
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Heavy-duty ......... Poor motor road .... --_- ?
,F
Medium-duty .. - - Wagon and jeep track
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Light-duty .......... Foot trail ......... .
\J U. S. Route State Route
GLENVILLE, N.C.
N3507.5-W8307.5(7.5
1946
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