20140969 Ver 1_Shoreline Stabilization_20140910

I 20140968
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
I.
2.
Applicant Information
Owner /Applicant Information
Name: M I �Ke FQ lP_Q
Mailing Address: Dr.
RECEIVED
SEP 10 2014
DENR -LAND QUALITY
STORMWATER PERMITTING
Telephone Number: of Iq- 3$3~ 4%q_ Fax Number:
E -mail Address:
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: JIMMY LEWIS & SONS GRADING & SEPTIC, INC.
Company Affiliation:
Mailing Address: 1024 HENRY STREET ROXBORO , NC 27573
Telephone Number: 3 3 6- 5 9 9 - 9 8 9 0 Fax Number: 336-599-1806
E -mail Address: _' C/& rLZZ ; Q A iLa •z0 ' Cla �
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
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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1. Location
County: Ris a-) Nearest Town: 'RQXbD ( U
Subdivision name or site address (include phase/lot number): W�'�'Qrl�
Directions to site please include road numbers, landmarks, etc. (This is not ,n,,eccessary if an adequate
vicinity map is included): MUD LnI� 9d• — -tAlrn IX �ts .
Su god I SI On .
2. Describe the existing land use or condition of the site at the time of this application: second
3. Property size (acres): I 5 (IC ur —S NaYw'
4. Nearest body of water ( stream /river /sound/ocean/lake): Wi co L, (1,
5. Describe the purpose of the proposed work:
6. List the type of equipment to be used to construct the project: w lnl M89ftT
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres:
3q5 c4 Ea± bpow n0Crna i Jt K _ A
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lak level and 50 feet land -ward in square feet or cress
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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): WCOL
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Please approximatety sketch the fallowing inforinafion an tWs playa
(please provide Onensians for each Item, such as is ft. x IGO ft);
1) AN proposed vegetation elearing (provide dirnenslons)
2) Lotion of rip rap or fill to be placed above the pelt Pond elevatim
3) location of tip rap or fill to be placed below the Full Pond etevaffan
4) The location of any proposed sums such as buildings, retaining
wafts, dodos, etc.
6) The location of any excavation or dredging below the, Full Pond
elevation.
6) Location of construction access corridors.

CJ,
Please aWroximately sketch the fbillowing idormation an Wis plan
tease bride +tensions for each Mem, such as 10 f. x IN It):
1) An proposed vegetation ete ing (provide dimens# s)
j Location of r rap or fill to be placed above the Fu
tl Pond elevation
3) Location of tip rap or fill to be placed below the FUN Pond elevation
4) The location of apy proposed sbWums such as buildings, retaining
vss docks, etc-,
6} The location of any excavation or dodging below the, Full Pond
elevation.
g) Logan of construction wess conidors.
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