20071097 Ver 1_Application_20070621

JUN 2 1 2007
07.1097
DENR -WATER QUALITY
4Y£TLANDS AND STORMWATER BRANCH
Tlie following is an abbreviated spplicatfon form for those applying fora 44X '4'Vate:
Q•atalfty Ceruficafion to.imotpact F!<;RC (Federal Energy Regulatory t~vznutnxssfo~-
regulated Ialce shore or bottom under the U.S. Army Corps of Engfr-eers l`errnit
C??34. Tb~i-;; A~splicafion cannot- be used for wetland or stream impacts.:Ple:3s~
provide seven (7) copies of this application and supporting inform:arion as we[l as :~
noon-refundable applies#ou fee to the Division of Water Quality of $244.(10 for
impacts of tia lake bottom of less than 1 acre and 5475.00 for impacts to lake bott~znv
of greater or equsl to 1 acre.
-Applications should be sent to:
:t~ivisitoh of'W'ater Quality Wetlaaads Unit
:t6:~411~ai1 Service Center
14:~leigh, NC 27699-1654
~o* ~Y,~B ~~r~
t~ is~~ set ~'
EFtfC C. AJ_5~lII:YER
Aegulasc•ry &, surf:
US Army Carps
of Engineers
l:. Applicant Informtatidm
1. 4wne:rr
Mailing

D.
WAtsungtott Disvict
lt.G
~~YMENTnn
~~h~-~UEt'`
(9 t!3) E3 76-13441
di~
~~JJ ~'ti
R C!H Fatir' of td~u se Road
:: uite~ 120
F:~leigl'., hC: 27E:15-3ti14
-32 ~ ~--------
2. Agent Infox~nation (A signed and dated copy of the Agent Authorization lett;x
must be attached if the Agent has signatory authority for the ownerlapplieant.)
Company.Afiiliation: -~------ ___--
Mailing Address: --._~---__.-
1 elephone Number- Fax Number: ~-~.~._,,,__•__~.,_
E-mail Address:
PY'OJeCt l•IlformatlOh
Telephone
E-3nai1 Adl
Attach. a ~ricinity map olesrly showing the location of the property with respect t..
`veal landmarks such as towns, rivers, •and roads. Also providz a detailed 'site
glare showing property boundaries and development plans in .relatiou• t•:~
surrounding properties. You may use the dzagraxnE below'to make a hand sketch of

your project. Also, see the eacample below for guidance, 73oth the vicinity map 3nL •
sits plan must include a scale and north arrovr. The footprints of all builduig._;,
imps rrvious surfaces, or other facilities must be included.
1. Location
i~ounty. ~SO h N'ear~st Town: ~~-W-o~('0.~
~5ubdivision name or site address (include phase/lot number):~~I~~-~s ~-~ , w _~ _ _ _~
laixec4ions to sits please inchuie road numbers, landmarks, etc_ (This is nc.~_
necessary if an ode uate vicinity a is included):_~~~~5,~_~v_.._.~ -, j-~y ~ (,~ ~_ ¢.
_ ass 3'~ ~: a a.~ ~:~ ~ ~~_ _~ .~.
, V _v...._. ... «.~w.r...... ~._
2. De~srribe the e~cist~ing and use or condition, of the site at the tinge of
application: ~-~C153'i~C7 fi~t2~ 39• y A-rrtE.~ - ......._ .--
3. Property size (acres):_ 3 ~ • of /-f-~/~
4. N~arestbodyofvvater(stream/river/sound/ocean/L~ice):~ La~~ ~.~~ -~-M.-,
5. Describe the purpo of the proposed work: 1-.~.5~, ~ o~ _-Se ~„,~
6. List the type of ~,uipmea~t to be used td construct the project:_~C~ {oA~- p ,e
_ Y..~~.__..__ ~_...-.
7. Arrcount of impact (ineludixtg all excavation, backfill, rip rap, reritinino walls, !
etc.) below the normal pool Ialre level in, sq a :feet or acres:
1 ~ wet[ ~ ~ --~Q~-,X. ~ =_1 d . ~
3 r ~ p - r ap_
8. a..vnount of impact (including all clearing, back fill, excavation, rip rl~,
retaining walls, etc.) above the norm~l pool -e level and 50 fezt land-ward in
square feet or acres: Z ( _ ZED /1it~ . SoM_C a~~..S
~.: t ( be less ~A~: ~, _ ~._.~__...~
b. Please describe vegetation above the normal pool lake le el a :i4 feee lan~j~ t
ward to be ixnp 'ted ((num~~r of trees ~~r instance:): L ~ h i ,~ (9~' VhG(,t ~ n rush
~p7~Iicant/Age>>t`s Signature Da ___._._.__._._
(_4gent's sign;inure is valid only if an authorization letter from the applicant is ~~rovidc;d.}

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~~uil f~~~trd: