20120775 Ver 1_Shoreline Stabilization_20120815

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20120775
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 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:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information
Owner /Applicant Information
Name: A 14 cr t- L -
Mailing Address: /".CJ .
S
A.% Eo e , AIC it 1209
Telephone Number: 910-
_IF..ax Number: 9 /t*- AtZV" 34044
E -mail Address: b4kJt4 N(6) 9ldN1Wi0i"44y/-ysGtrdVCt 41C,•COM
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the ow applicant.)
Name: / /7 7
Company Affiliation: T—
Mailing Address: C
Telephone Number: Fax Number:
E -mail Address: 4 VZ
II. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local land u
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.

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1. Location
County: 034f os"e/ Nearest Town: TD�I
Subdivision name or site address (include phase/lot number): 12tt Polml Q ✓[t% 14-QY
rores t
Directions to site please include road numbers, landmarks, etc. (This is no?14 esary if an adequate
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vicinity map is included): Eh7er FQ /f t� JOyer
4ae s d)d Lf 1"M ry Jr _ l rN;. Atnt4 D Va/ on teo r1J0,4
a "b d fir. vew�� -vh
2. Describe the existing land use or condition of the site at the time of this application: %1 t tYt
S 1 fe
3. Property size (acres): _ l Qe re
4. Nearest body of water ( stream /river /sound/ocean/lake): L- ak a 7 -W era rV
5. Describe the purpose of the proposed work: 0111AA e P X t l t T I N4 S PQ Lt1 �[�( GIJ
/tlll /'QP
rem 0Ye b� DOLL DLLSP V bol id »ew One.
6. List the type of equipment to be used to construct the project: h mC C. h D e
7. Amount of impact (including all excavation, backfill, ripe retaining walls, etc.) below the
normal pool lake level in square feet or acres: SA ec i /,Q W SA D r el hn e
RO "x4 = 85.2 " P belAw lake level
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 squale feet or acres:
e !
oofA
v r enrafe w / rl P ran. a/6 xY = 8�2 T p +f. dAOVe lake lewd.
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): We )"re CAN / 4re e 4- #Lp
ere l; m p V I 411 be ter T P reryA is yard.
Liv.— e,*-13- 12- �g rass •
Applicant/As-Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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Pleam approxiratety sketch the fo wawtng Wonnatiion on this plan
tease provide ohmnsions for each Item, such as 10 ft. x 1 QG ftj:
1, AD proposed vegetation clearing (provide dimensions) -- No n e
A Location of rip rap or fill to he placed above the Pun Pond elevation
3) Location of rip rap or fill to be placed below the Few Pond elevation
4) The location of arty' proposed shvetures such as buildings, retainIng
wals, docks-, ete.
6) The location of any excavation or dodging below the Full Pond
elevation. —None
Bj Location of construction access corridors.
AS ng e_XIS Png d rivewoy
rip rap
47 213
Ip rap, 4 213

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