20071018 Ver 1_Shoreline Stabilization_20070608

07- 10 1 8
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 lake bottom of less than 1 acre and $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
FAYM ENT
Applications should be sent to: RECEIVED
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
I.
Applicant Information
Owner/Applicant Information
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1NETI.APlD4 R:~lD S; n~;GA~a+4FER 5fi.4hG~i
Name:~phPrt F (;rP~ham
Mailing Address:~Z77A Gores Landing Road
Ocean Isle Beach, NC 28469
Telephone Number. - c Fax Number:
E-mail Address:~l [e-mail]
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: M4nt~nmer~ Nearest Town: Mt _ ~i 1 Pad
Subdivision name or site address (include phase/lot number):Ti l lery Tradition
Directions to site please include road numbers, landmarks, etc. (This is not CC
necessary if an adequate vicinity map is included):
See attached vacinity map
2. Describe the existing land use or condition of the site at the time of this
application: House under construction. Roof finished,
electrical, plumbing & HVAC rough-in finished or
in ~rnrPSt
3. Property size (acres): 0.68 acres
4. Nearest body of water (stream/river/sound/ocean/lake): Lake Ti 11 ery/Pee Dee River
5. Describe the purpose of the proposed work: Rip Rap bu 1 khead i ng and
construction of fixed dock. To eliminate erosion of bank
~iiA to i.~i nrl ~.iav~ anri hnat i.~avo~
6. List the type of equipment to be used to construct the project: Backhoe, Bobcat,
-8 *~^~~t-d--b~~g~w-az
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres:~~~rnx - egg sn ft.
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: 1500 sq ft to 2000 sq ft Rip Rap
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): Existing trees and
~tigenrs signature is vatia only it an autnorization letter rrom the appi~cant is proviaea.~

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Please appr~ximate~y sketch the f~llov~ring informat~an ~n this plan
~~lease wide d~nensions fir each item, ~ueh as i ti f#. x 1 Ufl f#~:
1 ~ ~!! prapased vegetation cl~~r~ing provide dirnens~ns)
.~~ Lo~catian of np rap €~r fill to be placed abar-e the Full Par~tt eleaation
~~ l.oaatian of rip rap ar fill #o Ise placed below the F Pc-nd ele~ua#ian
d~ The lacaition rif pr[sp+~d st~ctur~s h ~r~ildings, retalnir~
wall~> docks Vic.
~~ 1he l~tca#ian of an~r ex+cavativn ar dredging below ktre Full Pond
+~leva#iorr.
6~ Location of ,~ons#ructi+~n ac~ese corridors.
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