20130484 Ver 1_Application_20130507

20130484
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:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail service Center
Raleigh, NC 27699 -1650
L Applicant Information
1. Owner /Applicant Information Name: u I o� Ar-f�r'
Mailing Address: 1 N p Pt It SS g i l t L) -
ob
MAY 7 2013
D NR t U ITy
Telephone Number: 9l °I - & / a - 3 7 & y Fax Number: 919 - 80 3
E-mail Address: dA r-fk i L i- D SO 2, Q �/►� i • Cow,
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:
H. 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.

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Location
County: 1'� ('G� (i l� Nearest Town:
Subdivision name or site address (include phase/lot number):
,g yry n�
ova CQ
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): Ta 14v 98 FAs+ uA; ( 14- cii i;,d e oJ5 4v S 6 Ae Pd.
2. Describe the existing land use or condition of the site at the time of this application: Vactin f
3. Property size (acres): o S &Cd`15
4. Nearest body of water (stream/river /sound/ocean/lake): La & P_UVa. Le
5. Describe the purpose of the proposed work: C2yt4f- r_4- 1a-i Lou -4 c-.,d dock
Aa- 6..kr. rr4,Cv sLrcho Wz+J^ & &,,t6rNt,44o.1 e-�- butICtt,1_1
6. List the type of equipment to be used to construct the project: /m,
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7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: /o'x /o x y' o Md'r'(4 4r LO -f-!i P. ` cos`
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8.a. Amount of impact (including all clearing back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 5/�0 feet land -ward in square feet or agres
Q rGis �i .+/ 4, s c� // avL+GdAf F `ffO u d ( .5t Vcar.( -fr) e-11. i y-G
edikuai Lulk, -La p,^Cc..
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): L-7,rs f- %D' ,.Lee f Y-?x - s 40/0 w 1*11 Je e4eu1Y'O
r- .S L'y z' d f- r-r 'r-"O .4 ccVi krw1
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Applicant/Agent's Signature Date
_-_CA &ent'ss_gna_ture is ya#ckpplyjfwautJhPdzatiqn letter from the applicant is provided.)
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PRECISION 1/10.000+
go19a /'r°4rr�yJ
VICINITY MAP
NTS
Reference:
Lot 2089
LAKE ROYAL - MAP 11 OF 20
SHEET 4 OF 5
Plat File 1 Slide 104A
wood
Retaining
LAKE ROYALE° Let 2090's wood
Retaining Well
c Encroaches Onto
cp _` Lot 2089
Edge Of lake J 2_ 8.
Existing
Reference
Line —� - -y
2088
Overhead
Utility Lines
1'
m
c e
Existing 5 &0' Existing 68.5'
Reference Iron Reference iron
N18*53'20 "W _ _ _
6972' - - - - - --
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LEGEND
O
Storm Sewer Manhole
Q
Sanitary Sewer Manhole
Concrete Monument
haNow
or formerly
o
Power Box
o
Telephone Pedestal
o
Coble Television Pedestal
Power Pole
o
Light Pole
AC
Acres
8OM
Book of Mops
N T S
Not To Scale
ips
Iron Pipe Set
eip
Existing Iron Pipe
— —
— Line Not Surveyed
R/W
Right —of —way
cp
Computed Point (Not Set)
®
Drop Inlet
PRECISION 1/10.000+
go19a /'r°4rr�yJ
VICINITY MAP
NTS
Reference:
Lot 2089
LAKE ROYAL - MAP 11 OF 20
SHEET 4 OF 5
Plat File 1 Slide 104A
wood
Retaining
LAKE ROYALE° Let 2090's wood
Retaining Well
c Encroaches Onto
cp _` Lot 2089
Edge Of lake J 2_ 8.
Existing
Reference
Line —� - -y
2088
Overhead
Utility Lines
1'
m
c e
Existing 5 &0' Existing 68.5'
Reference Iron Reference iron
N18*53'20 "W _ _ _
6972' - - - - - --
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0 2089 0.3'—
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0 50 ACRES
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Lot 2090's Gravel
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70 00'
70.13'
S18'39'51 E
S18'39'51 "E
Power Pale
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SAGAMORE DRIVE
60' R/W
sip
Property Of
DAVID ARTHUR
LESLIE ARTHUR
1195 SAGAMORE DRIVE LOUISBURG, N.C.
Date-
02-20-13 James W Nipper, Professional Land Surveyor
Me: 5707 Hilltop Road
1 " =30' Raleigh, North Carolmo, 27603
'lie 1300 Office (919) 917 -7080 Cell (919) 637 -0491

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5 Printed:Apr 24, 2013
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