20150385 Ver 1_Shoreline Stabilization_20150422

2 0 1 5 0 3 8 5
The following is an abbrevia ed 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 five (5) 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 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
Owner /Applicant Information
Name-
Mailing Address-
Telephone Number: Fax Number
E -mail Address
o12 12 ad[2
APR 2 2 2015
DENR -WATER RESOURCES
401 & BUFFER PERMITTING
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:
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ail ii
Company Affiliation-_ II� �N LI) e d cl r C o 1't S - f-r-L c_76 G 1�
Mailing Address l O a a �r 3 -7
Telephone Number Fc)-6-___2% - �s%2 Fax Number:
E -mail Address-
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. `` e _ Ae I \ Nearest Town: Pf�b D M v-) r
Subdivision name or site address (include phase/lot number) (,cr�3q ' 1 1
(-Y" W res L'. 1Q,, N t
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate 1 7
vicinity map is included): _,& " C4 C
2 Describe the existing land use or condition of the site at the time of this application
3 Property size (acres) M __I (O
4. Nearest body of water (stream/river/sound/ocean/lake). D (MA.i1
5. Describe the purpose of the proposed work. 0� IC., nc, 02 A./1I<-k-,n �c
4 o k 11fi�� n12 SGP
6. List the type of equipment to be used to construct the project- 6! l'G,� mt)-vt - P �CCCcuc� i5�
7 Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc ) below the
normal pool lake level in square feet or acres tl� to '4 .
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:
S�- -,
8.b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance)- Q C GLSS
Applic Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Pnnt - Maps
Bing Maps
A Mooresville, NC
B 111 Channel Point Ln, Mooresville, NC 28117
Route 12.4 mi, 25 min
Page 1 of 1
My Notes
On the go? Use m.bing com to find raps,
afire ,cfions, businesses and more
A
Mooresville, NC
A —B: 12.4 mi
25 min
1
Depart W McLelland Ave toward S Broad St
249 ft
�! 2
Turn right onto S Broad St
Whataburger on the corner
0 3 mi
1► 3
Turn right onto W Wilson Ave
Marathon on the corner
1 3 mi
t4
Keep straight onto Brawley School Rd
Pass BP /BP in 2 9 mi
7 3 mi
IF 5
At roundabout, take 2nd exit
2 0 mi
F 6
Bear right onto Tuskarora Trail
1 1 mi
7
Turn left onto Syllabub Ln
0 1 mi
8
Turn right onto Ballycastle Rd
0 2 mi
1 9
Road name changes to Channel Point Ln
Unpaved Road
92 ft
B 10 Arrive at 111 Channel Point Ln, Mooresville, NC 28117
The last intersection is Ballycastle Rd
These directions are subject to the Microsoft® Service Agreement and for informational purposes only No guarantee is made regarding their completeness or accuracy
Construction projects traffic or other events may cause actual conditions to differ from these results Map and traffic data © 2015 NAVTEQ-
http //www.bmg com / maps / pant .aspx9mkt= en- us &z= 12 &s= r &cp =35 542529,- 80.883555.. 4/14/2015

ConnectGIS Feature Report Page 1 of 1
4WCONNECTGIS *WEDBI E?U Iredell
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The maps prepared for this website are generated from recorded deeds, plats, and other public records. Users of these maps are hereby notified that the information
provided herein should be verified. Iredell County assumes no legal responsibilities for any of the information contained on this site. Users are advised that the use of any
Df this information is at their own risk. All maps on this site were prepared using a 1000a €- Grid based upon the North Carolina State Plane Coordinate System from the
1983 North American Datum. The delinquent real property tax overlay is updated monthly. The information presented is not intended to be used or relied upon as official
notice of tax liens. For additional information regarding delinquent taxes, contact the Iredell County Tax Collector's Office.
http:// iredell. connectgis. com /DownloadFile.ashx ?i= _ags _ map5 fbbb8b54cc34773 ad7c2c53... 4/14/2015

ConnectGIS Feature Report
OCONNECTGIS #IREDELL
WE& HOSTING 'A'Itlift 1R. Nt
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Page 1 of 1
Iredell
Printed April 14, 2015
See Below for Disclaimer
he maps prepared for this website are generated from recorded deeds, plats, and other public records. Users of these maps are hereby notified that the informatia
rovided herein should be verified. Iredell County assumes no legal responsibilities for any of the information contained on this site. Users are advised that the use of a
f this information is at their own risk. All maps on this site were prepared using a 100033- Grid based upon the North Carolina State Plane Coordinate System from th
1983 North American Datum. The delinquent real property tax overlay is updated monthly. The information presented is not intended to be used or relied upon as officia
otice of tax liens. For additional information regarding delinquent taxes, contact the Iredell County Tax Collector's Office.
http:// iredell .connectgis.comIDownloadFile. ashx? i=_ ags_ mapcf5afb69cdf74863bc96508ff... 4/14/2015

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