20070873 Ver 1_Application_20070522

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2U~~u~73
The following is an abbreviated application form for those applying fora 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 $200.00 for
impacts of to take bottom of less than 1 acre and $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
I. Applicant Information
Owner/Applicant Information
Name: _._ v~ C~- ~''~
Mailing Address: S2- S

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Telephone Number: ~ a~ ~-/ 1$ -2 $ SOS Fax Number: SC? y~ e
E-mail Address: b ~LJ ~1~-~~ 1. ~ C:erti-
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: Fax Number:
E-mail Address:
II. Project Information
Attach a vicinity map clearly showing the location of the property with respect to
local landmarks such as towns, rivers, and toads. 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. C-Gl~ t: _ 1 b Gl. Nearest Town: ~J ~ ~r~ I ~S ~ ~
Subdivision name or site address (include phase/lot number): i~
Directions to site please include road numbers, landmarks, et . (This is not
necessary if an adequ t vicin~iaty marU is included): -~- ~ ~~ ~- i..1 50 --~c~ r n ~
51-.2 rr,~p r~ ~~ d d n~~~ I r+~ i Csti S ~C~2 r. ~ ~'~
a~--~1~~/i'C ~ r J~r ~ 0.rr~`Sok- F~ ~ C'ra ~"t
ak '~ l'C_ Y
2. Describe the existing land use or condition of the site at the time of this
application: ~~. ('(,~~" h c~ S I t L - 1,..1 c~ ~~ d e c~
3. Property size (acres): !~ l Ct LVCS
4. Nearest body of water (stream/river/sound/oceanllake): ~-a~C ~b~ ~C~ vv
5. Describe the purpose of the proposed work: ~U ~ hS~ G (~ r ~ ,0 - ~ GLD ~r1~ r S ~or e.
s-I cz ~ ~ l i Z ~i~ i u~ l O ~C ~~ v. l' y-) f'i d
6. List th,~ type of equipment to be ysed to construct the project: ~% r1 / ""~X!' L} yQ~r
1,~ ;, to ~~ ~~ -t~- / Ci' l1 - /f Uh .h r~~•- -~i'~ r' ~L-
8
Amount of impact (including all excavation, backfill, rip rap, retaining wall ,
etc.) below the normal pool lake level in square feet or acres: ~'~ SGI .
a. Amount of impact (including all clearing,
retaining walls, etc.) above the normal pool lak
square feet or acres: ~- ~5 S (~ ~~ ~ . '~'
back fill, excavation, rip rap,
level and 50 feet land-ward in
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): re Y1tr1 J Q.~ o ~' ~ ~~
n ~ Ulm C . y,,,,,r ~/v lAn..llP.r' ~~~ C Ali ~~Y , lr,~'D~"O~L. ~ 5
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Applicant/Agent's ignature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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Please approximately sketch the fo[leawing information a~n this plan
(please provide dimensions far each Itect~, such as 't0 ft. x ~ 0~ ft~:
1) All proposed vegetation clearing (provide dimensions).
2~ Location of rip rap ar fill to be placed above the Futl Pand~elevation
~) Location aF rip rap ar fill to tre placed glow the ~ Fud Pond elevation
4~ The locatiat~ 4f ar~y proposed structures such as bulidings, reta[ning
walls, docks, etc.
5! The location of any excavation ar dredging below the Full Pond
elevation.
6~ Location of construction access corridors.

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