20071269 Ver 1_Application_20070724

PAYMENT
RECEIVED
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.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
I. Applicant Information
07-1268
f;
~,~ y~
`,'lk:Tll~k j q' r..< ~•.^.!`~ s,~r,~ ; s: ~'t ~~AF,CH
Owner/Applicant Information }
Name: W i ~ ~ , ~ f~J ~= - /`~~ ~ % i ~~/ ~-%<//~ Y fl ~ G`1~1 `z.7-iN
Mailing Address: ~ ~~ , ~~~ > ~ ~ /
Telephone Number: ii~~ - y .3 `~ - ~-~s ~ Fax Number:
E-mail Address: ,^> ~ -~z r.ni a ~.3 ~~ ~ C' ~' ~ ~ T r/ ~ %o~,~ a rJ c ~---
2. Agent Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent his signatory authority for the owner/applicant.)
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 roads. Also provide a detailed site
plan showing property boundaries and development glans in relation to
surrounding properties. You may use the diagram below to make a hand sketch of
l`T ~'Ac--Nt`~

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.
Location
County: ~ ~' ^' ~ G- ~~ o`y E'er Neazest Town: ~ ~ • ~ / ~- ~ ~'~
Subdivision name or site address (inc ul de phase/lot number):
Directions to site please include road numbers, landmazks, etc. (This is not
necessary if an adequate vicinity map is included): ~_ « ~~ ~ s-
Gi GG,y s- ~~~` i~G ~~

~: c"

2. Describe the existing land use or condition of the site at the time of this
application: /V~'~ ~ ~ ~-- ~ :~ c ~ v"f1 ~ T i ~ ~ ~ ~~ ., :~ ~~?~
3. Property size (acres): i
4. Nearest body of water (stream/river/sound/ocean/lake): G I~'~ ~' -' -'L=-~ ~~ y
5. Describe the purpose of the proposed work: f~
6. List the type of equipment to be used to construct the project:
~~~~ ~~~
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in squaze feet or acres:
Rf P R{r~ ~' X /oo' = ado
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:
OQi O f~f7 ~ ~ ~ X / o o ~. S`aG ~.~..~
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be im acted (n ber of trees for instance):

Applicant/Agent's Signature 'Date `
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

BOOK 193 PAGE 378 rr,_,~,,,.,,,,, „
Survey For CdROL~A POlI1~R k LIGf17' COYP.INY
tel. PROGRErSS !s'NERGY CAROLINAS, INC J
~aat.wen IINRl:'CORDED -LILLY'S BRIDGE J ~j
bua 25 ~, N A ~ N A / :~
r= r.nel ~ 90 PARS OF 152 ~ i
m..t .dare.. ALEX-TIZER DRIVE
reenealp B7: CILEAD c,..-r AIONTCOMERY ~,t, NC
noon CerttneeGen: Tile enAJeel prepertY Ir net loeeted le . !r[dAL 1i.00D NASARD UIG
er eeerd Mm mepe turniaaed A7 HUD/~ Hood W eubJeet to nrUratrn ar drteLLed
need Nep .war. see cem/aunty r.nel r 11r.;s.41S2'd'~.1BtL, .
Ad r'/'.Y aw/w a Aefwri.r o/ L"N .fMir ,VOnfq=irj Cawrjc Ab1, Ce~r/hq alriM rant, her w vehplcl
r•r'•erl'D OvreY r/.'arfd' Aa"e.s. !!i, Adel1lltvf M. erM Mrd T "epf' Aare x1r aolique b, IiM d a
frrlw' dofN .~M /I, ]q'tJ iple/ e,. Ay Mrw4~ gxfr e/ hprcfliasi /s R= Cawf, a/ YanfO.f'+MJt .ee ,ferN
!!ru a?<r raukW>r fMw bN er lwr 'yeMArfM+M; negefh/ Kferr !e AeN fMrn ce'ndY rM cu+wif
ar0afii,ar mLnwc„'
1~•
-'TI NC GR/D NdPIN (NAO BJJ
,Q+ ~
r ~Iv
Carolna Power
& Cight Company /~,~ ~
Ti/leryP/anrLands t4 ~
OF442 ~,l / !cf }~
Pored No. 205 7' 7//
OB 90, Pg. r51 t ,y% 999
P.O.B.
N = SJ9, 75~ 90
f = 1,6BZ.61S57
(NAD BJJ
z
N
~-
~ i°.
n\
r4~~
~k ,
(VACANT LOTJ

lP
1„
..
/lyu.!!
i" _ ~Q•
~~ ~~~ER

Carolina Power
& Light Company
TrieryP/anrLends
OF442
,EU Parcd Mat 105
O DB 90, Pg`, 151
1
I
`
''
f i I I 1
r~_ ~.
~ I 1
I (~ a"~n ~~„ 1
~~'~
s rD
~ ~. ( .~ hi I N al7D'3. a '~
(1IL ~~ ~ ® ~ ~ F. I I
G
/ \ -01~9
Rn~
~
\ ~~, ~
ACEx
rnoi~~
A
M1S
~
J\V~ yf C
S ~
DYl1)
~ PEA n/•r'D C- f'
~
/
Cam/ine Power 6 Lyht Company ~'~ n I I
Tnery P/airt Lands \ ~~rA~~
DFS42
\ l ~'~
© / ~ I I
Pavcd Na 105 \ ~'p / I I I
AB 90, Pg 152
/ / ~ j I lLncxo
~
/
i I Etr . EaHip hn RN
1S;t~P1S^•OT:~C ~: [~'.?~[I~ rli'i I Ev-l:.ny-e,ro.
'
tF1
Ceodle/w Newt w /ll/( p0/ =I IeYC M AKY.r irrMMeMi ~1M'/I' Ir~:. \~~i r' 11 i 1•!.. N, I:. ..
a..NN.ewaarKd.v-satQOrJesaE-r
setlarl7 '~'F~'1''~ . LP• . /h" eM f01
.i'L!:1^'CL oe-a.Nea,r
,
r, r,; r ! -
1Air ynq• u wrA a C•irNp Comer !an/ a Sia ~• r` •.: ~ : , . .. :. ~ .
[. . „LAPb1L'N'f eaa . rehr ae.,:n:y
IDb pbt i ad,Kf re a.r lo,wnwr; ~D''ewnelra = RAp+r,-er-.e, ?((ibpfi0b.tlr~ --~!v:', ~.
f1 wN eI /Aif yeL .eo..r.r eef ,yp~ ,( ~, lI111 el T, ill,Klle'1. Ihi, pbt e
'
GRAPH/C

e
n wdirf rr w, /ech reel meY a e6oWN„e II t oreurofr fiW ,w,r/t SCALE
lW M.OMUr lroa" Anrrn n/M /e w .nrKOrrya ~ o/ wddY,lw ,eetyra 1RLYS ~ ZO
B,iDCl, 0, abro-MOrIh~PeM J Ae.ee'a. A4 JM /StM1p e.A A=irrofN al PCC 0 40 BO
w dowiq t-E-D7rY.
n.::. R.r:. d t.ls 91ewr w t-a-esvd slKr na t z ~ ,/ ayrwN
Rreifer Be/"rar Pohf R-J77 wl/ Poir/ M-Ja of lNfAR K SNrr Ale / t 1 1 " = 40 FEET
~I ~
7~
/ )\
s ,.•ubr~ . J tr
/ +~yl&
/ ~~~~
SLrneyeQ by 1 entl Ali'.. ..~,ll X 8th ~D Qy I
DAVJS-AfAR77N-POAELL & ASSOCLITES; 1NC. _ ~ ar .e tar rat: wt ta. pr.p.rtr Iw.
.ed , r D~ .co ae.n s Na! e"
ENGINEERING-LAND PLANNING-SURVEYING 'rottu sre~e'p ,eeee. er 1.a.nt
et{~et w!p . w tun el ~eaeot rrop.rlp
21B Getewoorf Avenue, Suits 102 ~ °°Q'°'° O'SfAj ~ - ~ ~ °° w
h Pofnt, NC 2T2B2
~ ;~ 1,34
Phone (336J BBB-sB21 -Far (33B) BBB-II;JB % .); o _
are _ 3=08_03 yam, 1 :t0' S-fM70 ' v ti.;~ ~ % o~.-+w+ L-JId1 -
34rwY.d ~G•_P/o(b1 ~r cn.rr.e_ JSD_ ~'r•,,ER1C OP,~~'~
- r ep don dIl' WM N.C.6.l., erderde q-70 end r est far Ilecor

FILED In nDNT00l'ltiY Gusty,
~~, ~ z~ ~ooct•.t ozoa~ ~n
wy. c, rte: a.o:r.~ .r a.a.
BOOK X93 PAGE 37q
n~rvaear courrnr
t~r2ooc~ ~3e.oo
,~~
~ 3$Do~-
a~•v
~ ~.e~~.
QUTPCLAIM DEED AND QUITCLAIM DEED OF ACCESS EASEMENT
Excise Tax: S
-~- Drawn by or under the direction of:
Snuth, Anderson, Blount, Dorsett,
Out of PIN ~: Mitchell, & Jernigan, L.L.P. (DWB)
(NO OPINION ON TITLE)
After recording return to:
NORTH CAROLINA
MONTGOMERY COUNTY
Hollers ~ Atkinson
P.O. Box 567
Troy, NC 27371
THIS QUTfCLAJM DEED AND QUITCLAIM DEED OF ACCESS EASEMENT, made and
entered into this 1 I day of SfPT , 2003, from CAROLINA POWER & LIGHT COMPANY, a
North Carolina public service corporation d/b/a PROGRESS ENERGY CAROLINAS, INC., GRANTOR,
to_ W ri.c,i Art C .Mq 0."t'tN + c..s t t= E~ k~Y R M A,~-rt,.~ ,whose addross
is P.p 8 0~ 3~ P'1 ; G t ~E A D ~[VC ~ "1306 ,GRANTEE (whether one or more);
WITNESS~TH:
That GRANTOR, for and inconsideration of the sum of Tcn Dollars (S 10.00) and other valuable
consideration to it paid by GRANTEE, receipt of which is hereby acknowledged, has remised and released
and by these presents does remise, release, convey, and forever quitclaim unto GRANTEE, his/her/their
heirs, successors and assigns, all right, title, and interest of the GRANTOR, if any, in and to the following-
described parcel of land (hereinafter referred to as the "Property'7:
Being Lot 25 as shown on the attached plat and lying on the castem side of Lake
Tillery, in Mt. Gilead Township, Montgomery County, North Carolina and being more
particularly described as follows:
BEGINMNG at an iron pipe marking the southernmost comer of the herein
wnveyed Lot 25 and a wcstem comer of Lot 24 as shown on the attached plat, the location
of said iron pipe having North Carolina (NAD 83) Grid Coordinates N = 539,754,90 and
E = 1,682,615.57; and runs thence along and with a southwestern property line of the
herein conveyed Lot 25 North 52°59'41" West a distance of 99.98 feet to an icon pipe
marking the westernmost corner of the herein conveyed Lot 25 and a southern corner of
Lot 26 as shown on the attached plat; thence along and with a northwestern property line
of the herein conveyed Lot 25 and a southeastern property line of said Lot 26 North
62°50't9" Fast a distance of 159.04 feet to an iron pipe marking the northernmost comer
of the herein conveyed Lot 25 and a southeastern comer of said Lot 26; thence along and
with a northeastern property line of the herein conveyed Lot 25 South 50°02'39" East a
s
q;4Y4~~

BOOK 493 PAGE 377
AUTHORITIES HAVING JURISD[CT10N GRANTEE HI /HER/1'H II2 HE 4 SUCCESSORS
A1~iD ASSIGNS HEREBY WANE AND FOREVER RELEASE GRANTOR ITS PA_RFNT
AFFILIATES DIRECTORS OFFICERS EMPLOYEES CONTRACTOR AND AGENTS FROM
ANY AND ALL CLAIMS CAUSES OF ACTION SUITS LIABILITIES AND OBLIGATIONS OF
ANY NATURE WHATSOEVER DIRECTLY OR INDIItECTr Y RELATED TO OR ARISING OUT
OF. THE PROPERTY OR THE ACCESS EASEMENT INCL DING WITHOUT LIIvIITATION AS
TO THE TITLE, PHYSICAL OR ENVIRONMENTAL CONDITION OF NON CONFORMING
STATUS OF. DEVELOPMENT OF MA_iNTENANCE OF AND/OR U E OF THE PROPERTY
AND/OR THE ACCESS EASEMENT
IIV WITNESS WHEREOF, GRANTOR has caused this QUITCLAIlbf DEED AND
QUITCLAIM DEED OF ACCESS EASEMENT' to be signed in its name by its duly authorized officer, as
of the day and year first above written.
CAROLINA POWER & LIGHT COMPANY d/b/a
PROGRESS ENERGY CAROLINAS, INC.
By: ;~~ ~%
Name: ~(,,,~ G• Ga ~//,~
NORTH CAROLIIYA
WAKE COUNTY ~
I, rvdvl~! _ ,DD~~ '//a Notary Public of ~,cJir,(C ~ Counry,
Nonh Cazolina, do hereby certify that ~r~ T / . Ca ~/~ ner5onally appeazed
before me this day and aclmowledged that hefsbris i/: « President of CAROLINA POWER &
LIGHT COMPANY, a North Carolina corporation d/b/a PROGRESS ENERGY CAROLINAS, INC., and
being authorized to do so, executed the foregoing instrument on behalf of the corporation.
Witness my hand and official stamp or seal, this _~/~ day of, f ~,0/~ ., ~rh , 2003.
Notary Public
My commission expires: Qav ~ (Notary Seal) HOWARD G, NIPPER
NOTARY PU9LIC
NUKE COUKT; K C
STa,TE O(' NUK'I'H ('ARULIVi1
CUI.'YI'Y OF MUNTGOMERY yN~
Ihcfurogningteni(icalrtsluf rs ~ ~ /~
i. tan;t cenificd u~ be ~urroct. Thir insrument was presented f~M istration this day arnl txwr and duly recorded in the Office of the
Ke;iVer of lkrcl~ al MOV'fCiOA9flRY COUNTY, NC in Rix~k ~3 Pagr 37~ Q
This the _~ ~ _ dry of ~j _ 3U ~ at ,~QD o'clock .[ M .
KAYt G. NURRfS. Rr~nirrni rk•rvt. in~~. YY) l .,~i•.. ~~ ~,.

~~ ,
Lake (Ful! Panda 0 7- 1 2 6 9
Full Pond ~dD`~'
tE o ~~
Shoreline lava ~
RIP RAP ,~~,G~,~ Fu~~
~ Z E~ ~ ~ 1 -~ ~ G-LGGL
c/
Please approximately sketch the fo0awing information an this plan
(please provide dimensions for each item, such as 10 ft. x 100 ft):
1) All proposed vegetation daring (provide dimensions)
2) Location of rip rap or fdl to be placed above the Full Pond elevation
3) Location of rip rap ar till to be placed below the Fu/ Pond elevation
4) The location of any proposed structures such as buildings, retaining
walls, docks, etc.
3) The location of any excavation or dredging below the Full Pond
elevation.
~) Location of construction access corridors.
~~ G

°~~'
w~ ~°~
~~ ~b A
:~~ ~ '"~ti~~ ~ ~
~ Sf ~. '
S 1+~ t g
430 215 0

~ _ ~ ~+~" ` ~ t ~ ~ R ~ JJ
C~

°~1
,,,\ ';
~,,.
`i
,,

~, 000 2, 500 0
.~

i/ ~
1 ~1
~ `~t
`, \ ~`',`~`~1
l
5, 000 Feet
~`11.t
n.
~,
1 ~
:~,

N-WF7�, 0 A
I rA
I r a