20130663 Ver 1_Shoreline Stabilization_20130701

20130663
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 M 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
I. Applicant Information ,
1. Owner /Applicant Information
Name: 'oN AV to (9a— I
Mailing Address: I' % c� • u��oX 3gl
7 A"C,G_y V %t 9 "C—
Telephone Number: �-r-t lit-' 7`?� — l S,"Z Fax Number:
E-mail Address: (nl"F %'E 211T ac.- 1A ti L-
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: cg !3 nwr
Company Affiliation:
Mailing Address: U L - 1 2013
Telephone Number: Fax Number. DIM R 1A1
E -mail Address:
s a
H. 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 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: f,�._ V,: LL Nearest Town: G- S 2G•
Subdivision name or site address (include phase/lot number): G,s dk�
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): Siz r=
C-14 tAkcr--
2. Describe the existing land use or condition of the site at the time of this application: VAc,MeJ �6AG>
3. Property size (acres): a Q AC ."-Z
4. Nearest body of water (stream/river /sound/ocean/lake): IJZCo i.AK-r-
5. Describe the purpose of the proposed work: QEmeoc- Wc-oc9do
WAL,t� '), SMA..._,c�nnyc�
A.,-O
6. List the type of equipment to be used to construct the project:o2►4-04rStc-a =E%age 3C& T,
3ah-I uiv."V? RXC.A%tAMVI-
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: Rigrnakty- l,- tx fig- g,..Pt-Fwr
I�iw�.arl /wwn� V�oc�r�-
62,64?Ad=� 7-- t-� Ir�aa nx�rv�ng�wL�
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
*Vve the normal pool lake level and 50 feet land -ward in square 1get or acres:
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): iMc9vs-M Sm At,- U�c,,c� -►
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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Map of:
889 Graystone Point Rd
Leasburg, NC 27291 -9615
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©2013 MapQuest - Portions ©2013 NAV"3EQ I Term I Privacy
02013 MapQuest, Inc. Use of directions and maps is subject to the MapQuest Terms of Use. We make no guarantee of the accuracy of their content, road conditions or route usability.
You assume all risk of use view ! 4 1, ire
6/27/2013
RR9 Gravctnne. Pnint Rd Veachnra NC 77791 nirPrtinnc T nratinn anal X/Inn I N/1Qr%n,i -ct D -no t -f' 1