20140072 Ver 1_Application_20140122

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 D (�
Raleigh, NC 27699 -1650
I. Applicant Information 101
1
1. Owner /Applicant Information ►Y i e A
�1!e Sdo a UAU1y
Name: o (' ►'� / �- "'�:.+�, __
ano-
Mailing Address: /AD
Telephone Number: TQ 3 sz'.yG Fax Number: o
E -mail Address:
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: BCA4naL( � S.
Company Affiliation: L %4 14> S A r ✓rte Cvns�fa6- /'`v✓�
Mailing Address: SloS s fi4 Q
Telephone Number: Fax Number: 90-83- -5_K­S__-S_—
E -mail Address: 33
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 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
nlan must include a scale and north arrow. The footprints of all buildincs. imnervious surfaces. or other

Location
County: l &Zenb," -A Nearest Town:
Subdivision name or site address (include phase/lot number): 7 le-,6.A C hA / LoZ- /7
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): A Sec ��ar � -e_�
2. Describe the existing land use or condition of the site at the time of this application: Provos- neai
5itc., t,t,
3 'Property size (acres): -7, 73 MW a C ca-S,
4. Nearest body of water (stream/river /sound/ocean/lake): I-ake—
5. Describe the purpose of the proposed work: 4e, C,_ , A 0% «#ox. SAD L. „
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 square feet or acres: roulkiy 7 /��/ ,,g�r� . h�n
S9 L
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 -war square feet or acres
ca I
0 �` /,2' .�iovc, �u 3.5r 4- .�' ��h�.�.� m l'�0 0 lS
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8.b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): _qr� d; r -f urn So
�
SC 5t5 t. .y.l 7 trccs 5 "to 3"
a1 n i y
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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Driving Directions from 3990 Charlotte Hwy, Clover, South Carolina 29710 to 13608 Sa... Page 1 of 2
Notes
mapquest'
Trip to:
13608 Sage Thrasher Ln
Charlotte, NC 28278 -6859
8.71 miles / 16 minutes
13608 Sage Thrasher Ln, Charlotte, NC 28278 -6859
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http: / /www.mapquest. com/ print? a= app.core. c628d8O9a3 l O7cc66f62f 7e4
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1/14/2014
A 3990 Charlotte Hwy, Clover, SC 29710 -8083
Download
Free
1. Start out going south on SC-49 S toward Blucher
AppO.2 Mi
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0.2 Mi Total
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2. Take the 2nd right onto Blucher Cir. Map
0.4 Mi
0.5 Mi Total
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3. Take the 1 st right to stay on Blucher Cir. Map
0.3 Mi
0.9 Mi To tai
41
4. Take the 2nd left onto SC-49 N (Crossing into North
Carolina).
0.4 Mi
..
7.2 Mi Total
t
��°EH, 5. SC-49 N becomes NC-49 N.
49
2.4 Mi
3.6 Mi Total
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6. Turn left onto Shopton Rd W.
3.1 Mi
6.8 Mi Total
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7. Turn left onto Island Point Rd.
1.4 Mi
8.1 Mi Total
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8. Stay straight to go onto Flying Eagle Ln. Map
0.06 Mi
8.2 Mi Total
14
9. Take the 1 st right onto Sage Thrasher Ln. Map
0.5 Mi
8.7 Mli Total
10. 13608 SAGE THRASHER LN is on the right. !/lap
13608 Sage Thrasher Ln, Charlotte, NC 28278 -6859
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http: / /www.mapquest. com/ print? a= app.core. c628d8O9a3 l O7cc66f62f 7e4
C?
1/14/2014

Urtving Utrections trom 3990 Charlotte Hwy, Clover, South Carolina 29710 to 13608 Sa... Page 2 of 2
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©2014 MapQuest - Portions ©2014 V TEO I ` _rms I Privacy
©2014 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. !,Is of Use
http: / /www.mapquest.com/ print? a= app.core.c628d8O9a3 l O7cc66f62f7e4 1/14/2014

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LOCATION MAP —NOT TO SCALE
AREA = 7.73 ACRES
NOTES: SURVEY MADE USNG EXISTING PHYSICAL
EVIDENCE FOUND AT TIME OF SURVEY.
SUMCT PROPERTY MAY BE SUBECT TO
RECORDED OR UNRECORDED EASEMENIS,
RIGHT - -OF—WAYS, SEIBACKS AND /Olt
RESTRICITVE COVENANTS NOT SHOYA
HEREON.
MINIMUM BUILDING SETBACKS ARE AS FOLLOWS-. _
FRONT-30' (FROM R/W) -
SIDE-15'
REAR-40' -
DRAINAGE AND UTILITY EASEMENTS DEDICATED AS FOLLOWS:
10' ALONG ALL REAR AND EXTERIOR LOT LINES
5' ALONG ALL SIDE LOT LINES
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THE SANCTUARY- PHASE 2
PB 43, PG. 711
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LINE TABLE
LINE LENGTH BEARING .
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LS 81.69 N32'30'39'W
Lr 20.42 N06.14'26'E
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