20070704 Ver 1_Shoreline Stabilization_20070425

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0704
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 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
I. Applicant Information
Owner/Applicant Information
Name: /hoRK T N~ ~
Mailing Address:l/~ Gri /.,.,a~%A~f /e3
Telephone Number: 1 a6' 23'x. -oS'S`O Fax Number:
E-mail Address: /1~l~GSN6 //r67~a~. ~~
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:
Company Affiliation:
Mailing Address:_
~~~~~~
tdr~i~ ~ ~ xOp~'

Telephone Number:
E-mail Address:
Fax Number:
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. 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 ~ I ~'
County: Nearest Town:
~,LW~ ~1 SS ic..~
Subdivision ite addre (include phase/lot number):
Direct' s to site please include road numbers, landmarks, etc. (This is not
nec sary if an adequate vicinity map is included): ~~s? ~ ~~ V o ~ ~ ~ ~- ~~
t'V~n
pt/~ vvW~^
2. Describe the ex stin ~?nd u~e~ for on ition of the site at the time of this .
application: ~~S t C`~ ~.1
3. Property size (acres): C~
4. Nearest body of water (stream/river/sound/ocean/lake): IV ~5S ~/~
5. Describe the purpose of the proposed yvork: ~ ~ ~ ~ ~ S
6. L
7. Amount of impact (including all excavation, backfill, rip rap, retaining wills, L
etc.) below the normal pool lake level in square feet or acres: ~~ ~ Z~ ~ ~SD~ ~A' ~T
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) ba. ove the normal fool lake level and 50 f land-ward in
square feet or acres: ~? ~ x ~ 17 ~ 17 U ~ '
b. Please describe vegetation above the normal pool-lake level and 50 feet land- ,.~/
ward to be impacted (number of trees for instance): ~ ~~ ~ ~~ ~"
ri~ ~ ~~
~ ivt ~ e,~d c.~
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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-. Shore Improvements
Check List
Building plan and Site plan
••V 1.
~2.
V 3,
v4
J 5.
6.
~7
~ 8,
V9.
Property Boundaries- (all)
Existing Structures {all)
744 MSL contour ~~'
Existing 736 MSL contour
Property corners
Lintits of projection
. `
11~ ~~~~
Location of proposed structures {to scale)
Depth of water (at foil pond) around. proposed structure
Sealed design and construction details
Seawalls
1.
2.
3.
4.
5.
6.
7.
8,
9.
10.
11.
12.
13.
)~ooters
Depth of wall below full pond
Full pond level
Weep holes
Excavation area
FiII area
Existing slope of control strip
Proposed slope of control strip
Drainage fill and rip rap
Tie into existing structures
Soil erosion and sedimentation .control
Constnsciion plan details
Shoreline erosion control measures
B. iers/Quays
v 1, Depth of water ~•~~~ ~~'~~~ ~'•~~''`'
~Z. Width of cove
t/'~3. Existing structures
v' Construction plan details
v'S, Shoreline erosion control measures
10.. Physical address of Iot
25~, ~
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li.
I 2.
13.
[ ~1~14.
Property inventory Tag No.
Tax Map, Block and Lot Number of the private property
Architect's or Engineer's Seal
Verification of permits from Army Corp of ~ttgineers or NC Department of
1Envirorur-ent and Natural Resources.
Shore Improvements
Check List
As-Constructed Certification
1. Information listed as 1 ~ t4 on Building and Site Plan certified by Architect or
Engineer on letterhead as having been built accordingly.
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