20100971 Ver 1_401 Application_20101118

2 0 1 0 0 9 T I
The f©flowuung is an abbreviated application loan for these apipiying for a 401 Water
tnalit?; Certification to innp?act FED'' (Federal Enprf : peulatore% Coupsmission?
regulated flake shore or bottom under the U.& Au Vin; ??_-arps. of Engineers Permit
CF'30e This Application cannot be used for mwetland yr 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 1;4,er Quality of 5?,0®o®0 for
impacts of to lake bottom of less than I acre and 5475.00 far impacts to lake bottom
of greater or -equal to 1 acre.
Applications should be sent tog
Division of Water Quality wYetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
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Vi/ETLRIND$q?yD5T0R.'a,; BRANCH
I, Applicant Information
Owner, Applicant nformation
Name:
Mailing Address: 2 9 00 t S+ 6
I b? At 0 8 0'
Telephone Number: -710 94 ° Fax Number: 't 443 iq
E-mail Address: M 0. r r- ",%a I,- CL a r a PA a x a +
2. Agent Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Ap--11- gicrnatorv authorM for the owner%applicant.)
Name:
Company Affiliation:
Mailing Address: ,_
Telephone Number:_ Fax Number:
E-mail Address: '
IL Project Information
Attach a vicinity reap 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
C.'te plai? must 1nClllde a scale and nojt'_n arr^,,?; Th?`ontpnnts of all ybuildin?s.
impe ious surfaces, or other facilities must be included.
Location
County: Nearest Town: A y
Subdivision name or site address (include phase/lot number):(f d 9 ir, I
Directions to site please include road numbers, landmarks, etc. ,(This is not
necessary if an adequate vicinity ap is included)? 3-o ;t-% H,?
R, - 4;,m 3 A 5r- cm I ?.-1 k, 5 Y,-. a'i_% I t, - ?-_
2. Describe the existing land use or condition of the site at the time of this
application: W aA r 4
3. Property size (acres)
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4. Nearest body of water (stream/river,'sound/oeean/lake):
5. Describe the purpose of the proposed work:
gy
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6. List the type of equipment to be used to construct the project: 4 ?_ A-C. V,
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7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the norrr?l pool lake level in square feet or acres:
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: 19%08 ?C r.% P P &- 0 k • 1000
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees forstance). 5
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Applicant Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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Please approximately sketch the following information on this plan
(please praovide dimensions for each item, such as 10 ft. x'100 ft):
1) X11 proposed vegetation clearing (provide dimensions)
2) Location 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 Pored elevation
4`I The location of any proposed structures such as buildings, retaining
walls 7 docks, etc.
5) The location of any excavation or dridging below the Full Pond
elevation.
6) Location of construction access corridors.
Lake (Full Pored.)
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