20120946 Ver 1_Shoreline Stabilization_20121011

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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: '✓
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Division of Water Quality 401 OversighVExpress Review Permitting
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information
1. Owner /Applicant Information
Name: High Ridge Farms LLC��0
Mailing Address: 721 Landsford Road
Marshville, NC 28103
Telephone Number: 704- 624 -3422 Fax Number:
E -mail Address: bruce.cuddy @yahoo.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 owner /applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E -mail Address:
II. Project Information
Fax Number:
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: Stanly Nearest Town: NopAvod
Subdivision name or site address (include phase/lot number): IT 12f Shore Farm Road - tjr,, .,A Afe - �
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): From Indian Mound Road, Turn west onto Shore Farm Road. Property will be ahead
on left.
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): 466 acres
4. Nearest body of water (stream/river /sound/ocean/lake): Lake Tillery
5. Describe the purpose of the proposed work: Remove existing T- shaped Pier and slope shore line
3/1, install fabric, and place class 2 rip rap on shoreline. Erect a 1200 sq. ft. dock and boathouse out of
treated yellow pine.
6. List the type of equipment to be used to construct the project: Track Excavator
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres:
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:
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance):
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(Agent's
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Date
an authorization letter from the applicant is provided.)

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