20120290 Ver 1_Shoreline Stabilization_20120320

2® 1 20290
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 five (5) 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 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
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699 1650
Applicant Information
Owner /Applicant Information
Name
Mailing Address
Telephone Number %ay-eg - y9�i Fax Number
E mail Address j 1al-s _ 3 4t rt�
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 f -03-93 /- ff3 /6 Fax Number 9963 a/-
E -mail Address Cc (Q-w- s 35 ;,w e=" A A- - L n g:k
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, impe VUurfaces or other
facilities must be included
w F oq �
PAR p2o
T�,yNG S ���QU�1�ryJZ
z4rFR�C
k

I Location
County 6a.s t",L- Nearest Town
Subdivision name or site address (include phase/lot number) G�� j►af /Lof S
Directions to site please include road numbers landmarks etc (This is not necessary if an adequate
vicinity map is included) Sc C- ,d D
2 Describe the existing land use or condition of the site at the time of this application
3 Property size (acres) 2Y3 a G r Qi
4 Nearest body of water ( stream /nver /sound/ocean/lake) Z4 -C,
5 Describe the purpose of the proposed work a ,Ott rn k . D
6 List the type of equipment to be used to construct the project �-
7 Amount of impact (including all excavation backfill np rap retaimng walls etc ) below the
normal ool lake level in square feet or acres
�
8 a Amount of impact (including all clearing back fill excavation np rap retaining walls etc )
above the normal pool lake level and 50 feet land ward in square feSt or acres / r _
8b Please describe vegetation above the normal pool lake level and 50 feet landward to be unpacted
(number of trees for or instance) // , o ztzr-r S- /cse -r -1- ::, v � ;-o
(Agent s signature is valid only if an authorization letter from the applicant is provided )

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION
LOT NO PLAN NO PARCEL ID 3 70:3-2035-/ ,Z J
STREET ADDRESS
Please print
Property Owner
Property Owner
f
The undersigned, registered property owners of the above noted property, do hereby authorize
of _ ('/,a UjS'✓t 6 �e f
(Contractor i Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached
Property Owner's Address (if different than property above)
z
Telephone ;70
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge
Authorized Signature uthonzed Signature
J
Date ` / ?-( Zi Date 3 i 2-- 142

Driving Directions from T -Bones On The Lake in Lake Wylie, South Carolina 29710 to 8... Page 1 of 1
mapquest Notes
Trip to:
848 Armstrong Rd
Belmont, NC 28012 -8858
7.81 miles / 11 minutes
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the accuracy of their content, road conditions or route usability. You assume all risk of use. erms of Use
http: / /www.mapquest.com/ print ?a= app.core.b82b8cdff67Ob6c7l a60cdae 3/17/2012

VICINITY MAP
(NOT TO SCALE).
100 YEAR FEMA FLOOD LINE 761
FIELD LOCATED 03 -12 -12
..yll— _ _ _S39::LO -V "1► 140.60
PROPERTY TIE
100 YEAR FEMA FLOOD LINE
PER 3703203592J
DATED 09 -28 -2007
I
REF, MB 77 -35 7
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LOT 51
VACANT
AREA
32,346 SUE
0.743 ACRE
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SURVEY OF
LOT 51, LAKEPOINT SUBDIVISION
SOUTHPOINT TOWNSHIP, GAST ❑N COUNTY, NORTH CAROLINA
PREPARED FOR TREY RALPH E BARKER
SCALE 1' =40' FLOOD CERI ICAMN
THIS IS TO CERTIFY THAT THE SUBJECT PROPERTY IS PARTLY
I n1 ATCn !Al A CDC/`I AI C //l/ln LA 7 AD Il AD CA A/YYlDn[Al/_ Tn
LEGEND
CO - CLEAN OUT
DB - DEED BOOK
EIP - EXISTING IRON PIPE
OR - EXISTING IRON ROD
EDP - EDGE OF PAVEMENT
FH - FIRE HYDRANT
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SURVEY OF
LOT 51, LAKEPOINT SUBDIVISION
SOUTHPOINT TOWNSHIP, GAST ❑N COUNTY, NORTH CAROLINA
PREPARED FOR TREY RALPH E BARKER
SCALE 1' =40' FLOOD CERI ICAMN
THIS IS TO CERTIFY THAT THE SUBJECT PROPERTY IS PARTLY
I n1 ATCn !Al A CDC/`I AI C //l/ln LA 7 AD Il AD CA A/YYlDn[Al/_ Tn

Driving Directions from T -Bones On The Lake in Lake Wylie South Carolina 29710 to 8 Page 1 of 2
Aft Notes
mapquest ar
Tnp to
848 Armstrong Rd
Belmont NC 28012 8858
7 81 miles / 11 minutes
T -Bones On The Lake
3990 Charlotte Hwy Lake Wylie SC 29710
(803) 831 -0170
1 Start out going west on SC-49 toward Blucher Cir Map 2 6 Mi
Q 848 Armstrong Rd Belmont NC 28012 -8858
httn / /www manrnject cnm /nnnt9a =ann core aR134d01a ? ?el I055 ?0 ?e0a5 3/17001?
®2
7
Turn slight right onto SC 274 Map 0 9 Mi
3 Turn slight right onto Pole Branch Rd / SC 177 (Crossing into North 1 9 Mi
Carolina) Map
®4
7
Pole Branch Rd / SC 177 becomes S New Hope Rd / NC 279 Map 1 0 MI
®5
7
Turn right onto Armstrong Rd / NC 273 Map 15 Mi
6 848 ARMSTRONG RD is on the right Map
Q 848 Armstrong Rd Belmont NC 28012 -8858
httn / /www manrnject cnm /nnnt9a =ann core aR134d01a ? ?el I055 ?0 ?e0a5 3/17001?

THIS IS TO CERTIFY THAT ON THE _12TH_ DAY OF _MARCH ----- 20P-- AN ACTUAL SURVEY WAS MADE UNDER MY SUPERVISION OF
THE PROPERTY SHOWN ON THIS PLAT AND THAT THE BOUNDARY LINES AND THE IMPR ❑VE NTS IF ANY ARE AS SHOWN HEREON THIS PLAT
MEETS THE MINIMUM STANDARDS OF PRACTICE FOR LAND SURVEYING IN NORTH CAR( N ❑ARD RULE 1600 (21 NCAC 56) AND THE RATI❑ OF
PRECISION DOES NOT EXCEED AN ERROR OF CLOSURE OF ONE (1) FOOT PER 10000 FEE PERIMETER SURVEYS NOR 20 SECONDS TIMES
THE SQUARE ROOT OF THE NUMBER OF ANGLES TURNED
SIGNED
Ec
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VICINITY MAP
(NOT TO SCALE)
NOTES-) 4 JAMES MAUNEY & ASSOCIrAftS P A
PROFESSIONAL SURVEYORS
1 SUBJECT PROPERTY IS ZONED GR 6405 WILKINSON BLVD SUITE 11
SETBACKS PER MB 77 -35 BELMONT NC 28012
4p FRONT 30 LICENSE NO C -2373
SIDE 15 TEL [phone]
REAR 40 —50 LAKE BUFFER FAX 704 - 829 -9625
2 THIS MAP REPRESENTS A SURVEY OF AN EXISTING PARCEL OF LAND
3 ALL DISTANCES SHOWN ARE HORIZONTAL GROUND DISTANCES
4 ELEVATIONS FOR FLOOD LINE BASED ON LAKE WYLIE LAKE LEVEL 56716 DATED 03 12 12
5 THIS SURVEY IS INTENDED FOR THE NAMED PARTY OR PARTIES ONLY NO WARRANTIES ARE
HFRFRY IMPLIFD ❑R GRANTED Tn ANY IITHFR PARTY FnR ANY PURPOSE
100 YEAR FEMA FLOOD LINE 761
FIELD LOCATED 03 -12 -12
«��-- _S39°20 57 if 140 60
PROPERTY TIE
100 YEAR FEMA FLOOD LINE
PER 3703203592J
DATED 09 -28 -2007
REF MB 77 -35
VIRGINIA LEEPER
DB 2886 -143
LAKE WYLIE
ZONE AE
S39 005 20 W
EIR 35 72 S34 °23 54 W 71 57
REBAR
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LOT 51
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AREA ®�
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0 743 ACRE
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66 9 i i 3 9fi 09.913N
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60 PUBLIC RIGHT -OF -SPAY MB 77 -35
EOP
R /W- - - - — — — — -- — - -- — -- — -- — — -- — -- -- -- - -- R/W
SURVEY OF
LOT 51. LAKEPOINT SUBDIVISION
O
90
S❑UTHPOINT TOWNSHIP GASTON COUNTY NORTH CAROLINA
PREPARED FOR TREY RALPH E BARKER
SCALE 1 =40 FLOOD CERIMCAIION
THIS IS TO CERTIFY THAT THE SUBJECT PROPERTY IS PARTLY
LOCATED IN A SPECIAL FLOOD HAZARD AREA ACCORDING TO
MAP BOOK 77 PAGE 35 THE CURRENT FLOOD INSURANCE RATE MAP
DEED BOOK PAGE COMMUNITY /PANEL 3703203592J
EFFECTIVE DATE SEPTEMBER 28 2007
CREW SS DRAWN JM REVISED TAX ID 218336 FLOOD ZONE X & AE
LEGEND
CO — CLEAN OUT
DB — DEED BOOK
EIP — EXISTING IRON PIPE
EIR — EXISTING IRON ROD
EDP — EDGE OF PAVEMENT
FH — FIRE HYDRANT
x
GW — GUY WIRE
MB — MAP BOOK
W
PP — POWER POLE
p,..
R/W — RIGHT —OF —WAY
�+
SO FT — SQUARE FEET
W
TBX — TELEPHONE BOX
WM — WATER METER
iV
C7�
LOT 51
VACANT I LOT 50
AREA ®�
32 346 SQ FT
0 743 ACRE
O
"p.
EIR �l�A�Y
�j4 REBAR
WMo R/W
66 9 i i 3 9fi 09.913N
EOP
ARMSTRONG ROAD
60 PUBLIC RIGHT -OF -SPAY MB 77 -35
EOP
R /W- - - - — — — — -- — - -- — -- — -- — — -- — -- -- -- - -- R/W
SURVEY OF
LOT 51. LAKEPOINT SUBDIVISION
O
90
S❑UTHPOINT TOWNSHIP GASTON COUNTY NORTH CAROLINA
PREPARED FOR TREY RALPH E BARKER
SCALE 1 =40 FLOOD CERIMCAIION
THIS IS TO CERTIFY THAT THE SUBJECT PROPERTY IS PARTLY
LOCATED IN A SPECIAL FLOOD HAZARD AREA ACCORDING TO
MAP BOOK 77 PAGE 35 THE CURRENT FLOOD INSURANCE RATE MAP
DEED BOOK PAGE COMMUNITY /PANEL 3703203592J
EFFECTIVE DATE SEPTEMBER 28 2007
CREW SS DRAWN JM REVISED TAX ID 218336 FLOOD ZONE X & AE