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Home My WebLink About20120824 Ver 1_Shoreline Stabilization_2012083020'20824 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 $240.06 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 Over 1650 Mail Service Center Raleigh, NC 27699 -1650 I. Applicant Information 1. Owner /Applicant Information sight/Express Review Permitting p [A � [2 Ob lJ I; AUG 3 0 2012 DENR . d R Brand Name: 9 / .m e r �n U-1 R Mailing Address: / 7,Q / a017 Gl nYCl ( A aPC A 2C2acl --Reg x I-),n ro A) C a % 7y Telephone Number: - 6 / - 496 Fax Number: 9 19 -6 4)!y - ( 9 e 9 E -mail Address: m; Ke hmn i / 4-o n @ M Al -h Q W S y o a n4 - Co rn 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: E -mail Address: II. Project Information Cd �LL,e 4- 4,r- P 2.S; y . N .e,t 33% _1699 -1Foe, 73 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 County: AGrs to Nearest Town: AOX 60ro Subdivision name or site address (include phase/lot number): /7®/ coAc- Ord cAcj c1 r . Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate vicinity map is included): ; % J naorJ U2Cii i cal _ �c�xboro; /U� 2. Describe the existing land use or condition of the site at the time of this application: 3. Property size (acres): 1.2-0 4. Nearest body of water (stream/river /sound/ocean/lake): 5. Describe the purpose of the proposed work: V-1--k2C, w d 6 %yt 5'--G �Oc_ k r-?.1Ay. ® n 6. List the type of equipment to be used to construct the project: 5 k-ne, (1 A-rE,,c "off 7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the normal pool lake level in square feet or acres: 2 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 square feet or acres: `700 fx r-e4,,;- a 757y 8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted (number of trees for instance): 2q Applicant/Agent's Signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided.) SAMPLE AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: LOT NO. 3 PLAN NO. PARCEL ID: / / 16 / Please print: 9 Property Owner: e /fn a y— 0j),Aa Property Owner: The undersigned, registered property owners of the above noted property, do hereby authorize C4,AR, '4i- LQ1J 1"S of M m Lew i S <* -'So ns i rl, -' SY4' G.- (Contractor / Agent) (Name bf 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): Telephone: X119 - 6 16 - W& We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. Authorized Signature Signaatuurrree Authorized Signature Date: Z5 �o� /�- Date: Please approximately sketch the fobowing infonnation on this plan (please provide dimensions fear each item, such as 10 ft. x 100 rt). 1) All proposed vegetation clearing (provide dimensions) 2) Location of rip rap or fill to be placed above the Pul Pond elevation 3) Location of rip rap or fill to be placed belay the FtA Pond elevation 4) The location of mW proposed shWures such as Buildings, retaining iw ls, docks, etc, 6) The location of any excavation or dridging below the Full Pond elevation. 6} Location of construction access corridors. 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IM-0 WII N DI nO m - INmx K ImA m 7, w ;, w 0 00 A f 00m I W z QQ m a Amn 410 n - z j X10 r n 10 m. a Z O m 0) (n D n 0 Z ' I Iw CO- - O N Nom... O r 10) - O WN -- ......... O �O Z O1ZH A W N �1 � N �I O G) i - • D n D 010 r n�lo� 0�0 -0'mI „ *�OZ z Iz, < _U D 1H G) I I1AC r T. lr G)D ;m rml�Dr I 112n W mHW 117- I O�Nn DHI 2 Dim O m ICI -INNn mlm2 rr ��' > 0 090 I _UH r KID m�I 0rI �I {m ID 'U o n �5I O). O IN I;u U) --,1 U) n 0 0_. A c� u m �N mD Ui m CT Z �N 00 0) OD -A NN NO)OON N WQ)N�7 K) A Ull A N � 000B 000101 00 OD W Ln (DH A - (0Im SAO) ONO 000 M Kn P0, N - OOUlr> OANU11r O N (0 W,Ic O 0) N OD Ir d 0 4 O�- NO mm� DDI -1 r nn �- - -D n < �N Am 1O z O H OOn {Z �I 0 I — * E --i m m I = -n ru < C �ro < Iz (n ffi 0 Iu OOOH 0 o rn O I O�IzI W NOH x OOI(n� _ II m 0 I0IIII w 0�1 C: > I OOM WI ODiN OIIIx min 21m -O r-K __ir of- *10 zz U1 2 T orA� I� n -Om>l> lwcn - � �Orn h - nmm;u F .20(01; cl 0 Z U) IGO - -i c m � I� OO m J(n0m I D N ;0 J U) Q .. ° (� > Iz � G N w iZ W 0X do N Cl 0 z 7710 rn� Drn C w O) N N N N a ConnectGIS Feature Report Page 1 of 1 Welcome to the Person County GIS Website ConnectGIS has been prepared for the inventory of real property found within Person County, and is compiled from recorded deeds, plats, and other public records Users of GIS system are notified that the aforementioned public information sources should be consulted for verification of the information in this system. Person County, Mobile 311, ConnectGIS assume no legal responsibility for the information in this system Grid is based on the NC state plane coordinate system, 1983 NAD 1535 N ' >` 3599 13 3600 N $Q� 1387 6Q g r 1 71 Feet �> http: / /gis.personcounty. net/ connectgis _v6/DownloadFile.ashx ?i= ags_mapIOba924dfa974... 8/21/2012