20110550 Ver 1_401 Application_20110608

*
VIE,
OD
JUN s 2011 I
a
BOATHOUSE, DOCK, and RIP-RAP
PLANS FOR
RANDALL S. BEARD
Physical Address: 743 Sagamore Drive
Mailing Address: 386 Lake Royale
Louisburg, NC 27549
Phone: [phone]
Cell Phone: [phone]
Submitted June 8, 2011

pF W AT
CO
o c
Abbreviated Application Form
For Regional General Permit 80 (Bulkheads and Riprap)
For Section 404 Regional General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This application cannot be used for wetland or stream impacts.
This form is to be used for projects qualifying for the U.S. Army Corps of Engineers' (USACE) Regional
General Permits 80 (General Permit No. 197800080) as required by Section 404 of the Clean Water Act and for
the North Carolina Division of Water Quality's (DWQ) associated General 401 Water Quality Certification.
This form is also to be used for any project requiring approval under any Riparian Buffer Rules implemented by
the N.C. Division of Water Quality. This form should not be used if you are requesting an Individual 404
Permit or Individual 401 Water Quality Certification.
The USACE is the lead regulatory agency. To review the requirements for the use of General permits, and to
determine if general permit 80 applies to your project, please go to the USACE website at
www.saw.usace.army.mil/wetlands/index.html, or contact one of the field offices listed on page 4 of this
application. The website also lists the responsible project manager for each county in North Carolina and
provides additional information regarding the identification and regulation of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant which 401
Certification will apply until the 404 Permit type has been determined by the USACE. Applicants are
encouraged to visit DWQ's 401/Wetlands Unit website at http://h2o.enr.state.nc.us/ncwetlands to read about
current requirements for the 401 Water Quality Certification Program and to determine whether or not Riparian
Buffer Rules are applicable. The applicant is also advised to read the full text of the General Certification (GC)
matching the specific 404 Permit requested. Applicants lacking access to the internet should contact DWQ's
Central Office in Raleigh at [phone].
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms, photos,
eM o e app icable USACE Regulatory Field Office.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated as
optional. Incomplete applications will be returned. Submit seven collated copies of all USACE Permit
materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center, Raleigh, NC, 27699-
1650. If written approval is required or specifically requested for a 401 Certification, then a non-refundable
application fee is required. In brief, if project impacts include less than one acre of cumulative wetland/water
impacts and less than 150 feet cumulative impacts to streams, then a fee of $200 is required. If either of these
thresholds is exceeded, then a fee of $475 is required. A check made out to the North Carolina Division of
Water Quality, with the specific name of the project or applicant identified, should be stapled to the front of the
application package. For more information, see the DWQ website at
http://h2o. ehnr. state.nc.us/ncwetlands/f`ees.html.
Page 1 of 4
Office Use Only: Form Version August 2006
USAGE Action ID No. DWQ No. 20 1 1055 0
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Applicant Information
1. Owner/Applicant Information
Mailing Address:
PAID
Telephone Number: Y117- IVZZ- 31- q& Fax Number:
E-mail Address: R SA 4-9 e' W. (- - gA . & 001
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:
Company Affiliation: -
Mailing Address:
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. 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
D
County: ycl it ?r???? ji <4st Town:
Subdivision name (include phase/lot number): f_ tf- ?eTT cr/ e. 1-.14- / 5 3 R1
Site coordinates: ' j + 3S JD
8 l
Decimal Degrees (6 digits minimum): ON !4, op °W -79"
Directions to site (include road numbers/names, landmarks, etc.): Z.v 4 Lek r- R,, a
k z /J
f'l?6sa"i?` 6a??'? ?m?ir aP? - / LL?"1' ?n? v 1?•?(/ ? /fit/ri ?e???' -?.bt'?'9
Page 2 of 4
3. Property size (acres): a, 16 `f h t'r t
4. Name of nearest named receiving body of water(streamhiver/lake): Le L fl v cal'- '
5. Describe the purpose of the proposed
A -!
6. List the type of equipment to be used to construct the project: As C? / ~ w°-,-?
u
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:
ty/o?rt?
3f 3j ?Szlow W,3k? ?i? e 2'3 Lazi 4GiJL i?n 4t lt-? e,
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:
/'h??i.+ct? Cries 7:?f'i.°t (idylo jc /Qf'/.ar
b. Please describe the vegetation above the normal pool lake level and 50 feet land-ward to be
impacted (number of trees for instance): ly aku ?wl tv 00 4-1 -1 /,,ccr -
J
. ApplicantlAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Page 3 of 4
Lake (Full Pond)
Full Pond
h- Orelina
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Please approximately sketch the following formaff-on on s plat
(please Provide dimensions for each item, such as IS #t. x'100 ft):
1) All proposed i getatiota hearing (provido dim ens on
A Location of rip rap, rfll to be placed above the Fall fond elevation
3) Location of rip rap or fill to be placed below the Fut Fond elevation,
4) The location of any proposed strictures such as buildings, retaining
vialls. docks .5 em
6) The location of any excavation or dridging below the Full Pond
elevation.
6) Location of construction at cest corr"Idors.

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