20120225 Ver 1_Shoreline Stabilization_20120229

2®120225
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 & 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 $240 00
for impacts of 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
4
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center (�
Raleigh, NC 27699 1650 t� (J D
I Applicant Information FEB 2 9 2012 QUALITY
WE DEkR 1 Owner /Applicant Information
nANDSAMD STORMWATER BRANCH
Name -Wyw t7
Mailing Address E4v2 ,f
�30 pi v tic. 27 i3
Telephone Number 25 z H6ci %373 Fax Number _ 9ig *7 - o Z 77
Email Address F R- 10(4 r A . G Lq
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
Telephone Number Fax Number
E mail Address
II Protect 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

4

Location
County r,�asui►►J Nearest Town Bw,.1►.l
Subdivision name or site address (include phase/lot number) 1" ftQyA,,- % i ';3 ' 0 B 2. �-
Directions to site please include road numbers landmarks, etc (This is not necessary if an adequate
vicinity map is included) Emm^. Lxke -,5-nw 5; �,c,w7, 6„1
GtaL `►cnl,J � Taxed R iG VaT dwl -'!5-4170-4c' -E A2�dt Ar 6133 , 0132-p-
2
Describe the existing land use or condition of the site at the time of this application
3 Property size (acres) %.%s
4 Nearest body of water (stream/nver /sound/ocean/lake) R L-*- & 96ALG
5 Describe the purpose of the proposed work 7-0 X -Z'i + [ice ��� , iox l2 -A 5K►
Ri1RA V (Z / lox- I7. a .c zX.S M f-4)C 22-6 6 6jp%Wi W
6 List the type of equipment to be used to construct the project
7 Amount of impact (including all excavation backfill np rap retaining walls etc ) below the
normal pool lake level in square feet or acres ice.- go-.-,c ,�x►z
-�o Sr-. M Doc - APP -Cx 276 or S Aa .A.— Lr 9-,P RlN?
8a 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
O;: 1- P it mf v tL
8 b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance) rZg"wjc. APR J3 T,ze--- -si Au -5vMpS
To ►`�� Mti� �a �- Jam, -rte
sS g=ture Date ' I
e is valid only if an authorization letter from the applicant is provided )

OF W A
p� pG
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o <
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 (USACF) Regionll
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 lndiv idu11404
Permit or Individual 401 Water Qualitv 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
w-wvv 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 Carolin i and
provides additional information regarding the identification and regulation of wetlands and w iters 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 DWQs 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 whethei or not Riparian
Buffer Rules are applicable The applicant is also advised to read the full text of the Generil 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 narratix es maps d it i forms photos
M-16 e app icable USACE Regulatory Field Office
401 Water Quality Certification or Buffer Rules All information is required unitss otherwise stated as
optional Incomplete applications will be returned Submit seven collated copies of all USACE I'cimit
materials to the Division of Water Qualitti 401 /Wetlands Unit 1650 Mail Ser, ice Center Ralcigh NC 27699
1650 If written approval is required or specifically requested for a 401 Certification then i non rtlund iblc
application fee is required In brief if project impacts include less thin one acre of cumulative wetl ind /water
impacts and less than 150 feet cumulative impacts to streams then a fee of $200 is regtiiicd It cithei of these,
thresholds is exceeded then a fee of $475 is requited A check made out to the North C irolina 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 websitc 11
http //h2o ehnr state tic us /ncwetlands /fees html
Page 1 of 4

Office Use Only
USACE Action ID No
DWQ No
Form Version August 2006
(If any particular item is not applicable to this project please enter Not Applicable or N/A )
Applicant Information
1 Owner /Applicant Information
Name 7�4". yj-"x -ce—
Mailing Address --aL� E
Telephone Number X51- q(, Fax Number 9i9 1197 0 Z77
E mail Address mow►
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
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 AIso pro,, ide a detailed site plan showing property boundai ics and
development plans m 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 applicants 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 I I by 17 inch format howeNer, DWQ may accept paperwork of any size DWQ prefi.rs
full size construction drawings rather than a sequential sheet version of the full size plans If full stye
plans are reduced to a small scale such that the final Version is illegible the applicant will be informed
that the protect has been placed on hold until decipherable maps are provided
Location
County - a Nearest Town 0... �"
Subdivision name (include phase /lot number) -t 3 2 4
Site coordinates
Decimal Degrees (6 digits mnumurn) °N °W
Directions to site tmclude road numbers /names landmarks etc) -mev Lu..a- r�al_
E,v i t24N",c�r 5r-v-%-,f 6—ry- twT ;Z ily 'IN ,Amr &k y. Ar Of 13 015�.
Page 2 of 4

3 Property size (acres) 1.16
4 Name of nearest named receiving body of water(stream/nver /lake) i� RI.a C- J 4NE -M-1-
5 Describe the purpose of the proposed work Go.--r 14c', e' wx m 1cr :�L
jmij! t 37- DaA-S Art lox 225 t 44 /A.0 4AP
6 List the type of equipment to be used to construct the projectgAe-iag- — &A aa?"
7 Type and amount of impact (including all back fill excavation, riprap, retaining walls other fill
etc f) below the normal pool lake level in square feet or acres and distance ff�r/om shoreline
Zox -2-1{ &*z Ao4aa 10 K I'L -�/ 716 Poi � � �UiC 32 L?.C.iL -� /,! fg9A ZZj'
8 a Type and amount of impact (including all clearing back fill excavation riprap, rttainmg NN a115
other fill etc ) above the normal pool lake level and 50 feet land ward in square feet or acres
2a� x ati f3�o, l , /max Q at—r 151L -O-AMP Ctl 1, k 3L i7rr .� s �PO�K Z1s,
b Please describe the vegetation above the normal pool lake level and 50 feet land ward to be
impacted (number of trees for instance) Ayr,!�h 15 7aggS AL.-
-'irL,MP , 7S MA Al
A cant /Age 's Signature Date /
(Agent's valid only if an authorization letter from the applicant is provided )
Page 3 of 4

riease approximately sxeicn ine Tottowtng inrormauon on ints plan
(please provide dimensions for each item, such as 10 6t x 100 ft)
1) All proposed vegetation clearing (provide dimenstans)
zj Location of rrp rap or 1111 to be placed above the Full Pond elevation
3) Location of rwp rap or fill to be placed below the Full Pond elevation
4) The location of any proposed structures such as buildings, retaining
wtalls docks etc
6) The location of any excavation or dredging belo4v the Full Pond
elevation
6) Location of construction access corridors

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