20071692 Ver 1_Shoreline Stabilization_20071005

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The following is an abbreviated application form for those applying fora 401 Water
3 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 p ~ ~ ~ LI V
1650 Mail Service Center ~J ~!/ D
Raleigh, NC 27699-1650
O C T 0 5 2007
' UENR -WATER QUALITY
I. Applicant Information WETLAI~sM1oSTE)R.MINAT6RI~RANCI~1
1. Owner/Applicant Information
Name: Gtc ~~
Mailing Address: 23 Cc ~ ' r I
- SN~~er-cu NG 2?3d~3
Telephone Number: 33~ - 23 A~ -q 31x3 Fax Number:
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: ~,' J ,~
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
II. Project Information
Attach a vicinity map cleazly 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
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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: f-)C r 5 c --~ Nearest Town: ~. o x bo ~- o
Subdivision name or site address (include phase/lot number):, k, P ~~}. [~ t ~ ~
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included):
! .r> ~l- c'` the r ~ ~G~~o~ ~ ~t~,~eS
~'~i~
2. Describe the existing land use or condition of the site at the time of this
application: /.~-i- (,~,~;1-f~ bcc~+,~~ ~c ,
3. Property size (acres): ~ CtCr2
4. Nearest body of water (stream/river/sound/ocean/lake): ~-~- u~ ,-, r~ k Q,
J
5. Describe the pu se of the proposed work: ___ ~ u ~ o Ake,
~'~a ~~D ~h Shnre(,r.o. ~, ~l1<sCreer, 11.1u.1o,;.~
6. List the type of equipment to be used to construct the project: p h C ~;}'
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres:
L I/~. Gt-cre,
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-ward in
square feet or acres:
b. Please describe vegetation above the normal pool lake level d 50 feet land-
ward to be impacted (number of trees for instance): 1(/
a~
err-- ,--.,...b.,..~ ~ ~~~~a~u~ c Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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Lake Full Pond}
Full Pond '~
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Please a~proximateiy sketch the ft~llowing information ~n this plan
~ple~ase prtivide dienensians ft~r each item, such as is ft. ~ 100 ft).
1}Ali propo$ed veg~tatian clearing ~pravide dirnensians}
2j LQCa#ion of rip rap 4r fill t4 be placed above the Full Pand elevation
3f Location of rip rap ar fill to be placed below the ~u~ Pond elevation
d) The location of any proposed structures such as buildings, retaining
wails docks, etc.
~~ 1'he iocartion of any +exeavation or dredging below the Fuli Land
elevation.
BI Location of construction access corridors.
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tvtapl1uest: Maps, Addresses, tsus>ness Directory cYi Satellite Photos
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[147-199) Duck Pointe Dr
Roxboro NC
27574 US
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