20130054 Ver 1_Shoreline Stabilization_20130122

r_
20130054
The following is an abbreviated application form for those appWng for a 401 Wager Quality
Certification to impact FERC (Federal Energy Regolate y Capon) regulated lake shore or
bottom under tl:e U.S. Army Corps of Engineers Permit GP30. This Application cannot be used
for wetland or stream inaipaets. Please provide seven (7) copies of this application and supporting
information as well as a non - refundable application fee to the Division of Water Qusiity 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 4010 V= 012gin WIFE Tees Review Permitting
1650 Mail Service Ceder
Raleigh, NC 276991650
I. Applicant Information
1. OwnedApplic:ant information
Name:
Mailing
Telephone Number: , —V V — d99- X 1.2 Fax Number. %5—
&mail Address: 1YL
If
2. Agent Information (A signed'aad dated copy of the Agent Authorization letter mast be attached
if the Agent has signatory authority for the owderlapplicant.)
Name:
Company Affiliation:
Mailing Address: D
Telephone Number. Fax Number.
E -mail Address:
1"� 2 2013
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 deta W site plan showing property boundaries and
development plans in relation to surroundigg prvpertes. You may use the diagram below to make a
hand skstcb of your project, Also, see the example below for guklance. 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 inchtded.
9

1. Location
County: Nearest Town:
Subdivision name or site address (include phase/lot number): T/1�T o/�
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included):
2.
3.
4.
5.
Describe the existing land use or condition of the site at the time of this application:
Property size (acres): at—,z-
Nearest body of 4ater (stream/river /sound/ocean/lake):
Describe the purpose of the
List the type of equipment to be used to construct the project
7. Amount of impact ( including all excavation, backfill, rip rap,, retaining walls, etc.) below the
normal pool lake level in square feet or acres: ,�i'ec/A2 _3v r 5% X 3 ac������i
v
8-'& Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above thfe normal pool Ike �vel and 50 f2�tjanc� ward in square feet or acres:
3 /S�i /ao 00 . <., g
8.b. Please describe vegetation above the normal pool lake leve and 50 feet landward to be impacted
(number of trees for instance): Rh���ar
C G �
App icant/Agent's Signature bate
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

North CATolifia.'
I s.+cnaes ts.� marwm r Gertup+Tnet '-- pine was
drawn tmdef">ny direct auparvlaltin from nn actual
survey made under.,my,Wrect supervision from deed
descriptions recorded as follows:
D.B. 361, PG. '664 % PIN # 6564-04 -94 -8709
Lots 1343 -3451, TM y Beach, and. Addition
Plat Bk_ . 1, Pa: 214
That the boundaries not surveyed are clearly
indicated as dashed' lines as drawn from information of
record as shown hereon. That the Ratio of Precision
as calculated to 1/ 10-00 t That this plat was NOT
prepared In accordance with G.S. 47 -30 as amea�
%Maass my hand and Official Stamp or Seal
Dixie Land Spx7eyuitg, PLLC .
4278 country. Caul Iw. (04) e94 -5810
Wadesbora
MC .28I70
SURVEY STATUS
1. That the survey is of an existing parcel
or parcels of land and does not create a new
street or thane an existing street.
Scale: 1 " =40'
0' 40' 80' 120'
Notes: (x if applicable)
X L No KC Qrld 70md• Atkin ROW of thb alts
$ 2 An dlat"M an hatsoaw AM measmemenL
and aw not adhtdad by a Brtd fwtar.
\ a Tbla prep ky net Atha a flood Pans Arm
rffeatlw beta:
'\ $ 4. Ataa a mpatad by Coatdlmtea
\ \ 8 a Pn-%a, as ahoen hmeoa to mr ----W
\ / ` \\ \, •\ haw not ban obeabsd or apposed by an
\/ \ yant of the oountr for an oa—a to
08-0 apt—
Terry Letts ��� \ \\ ••\
r r qs Rabari� D.B. 1149, PG. 339
\ /••
r r e\ W b IRS \ \\ /•� �,.
Ot �
r r Cn \ \\ ' /••Record North
r r Q� 68 Robar PP \ \\ �• D.B. 1149, PG. 339
rrrr 00
nts
r .� r .� .--• got / � • \ N \
2 Story rp \ \ ••\
r r "CC^ Dwelling o \\ \
a0 w � IPF oa 12.78 \ \\ ••\
/dog �: ?p �� 3$9 / \ \ '•\
Lake Tillery '°"`6 s '� / / �•\
M.
IRS \ \\ •'\
r �I•�y�7�}� I \
L�\iYi1�3�J \ \, �•�
.These standard symbols will r r i ` •3y33• �\\ \ \ \`
be found in the draering.
MF - Iron Rod Found r r
r r r r r
je
-UM -E Ison Rod Set r �---
IPF =Iron Pipe Ford
CC Campnted Corner Not Set
- e Now or Formerly Y J_
B 6 6c Jesse Hayes \
D.B. 383, PG. 537 '•
� \I
Rebar `\ a /, 10,62$►sSQ
0.24 A�1
Plat; of Property Surveyed or.
MitcheIll.
and W fe
Janie : C xj
ftwery located, tit; i
FT.
. i
j 078 Berry HM Drv. Center Twasp., 8t�w* ty, ;NC
II Drawn Sr.' 1K1 I Date: 09/M/09 Jo* 14109 j
II � I

- �.
-- -° ::
�.r ;: -

IRS
sow
A
Ilk
rs
•
"I
&A
AAM
W-