20150518 Ver 1_Shoreline Stabilization_20150526

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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 five (5) copies of this application and
supporting information as well as a non-refundil l&� Q_ication fee to the Division of Water
Quality of$240.00 for impacts to lake bottoof�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 P ' in
1650 Mail Service Center �@ nn
Raleigh, NC 27699-1650 V D
I. Applicant Information MAY 216 2015
1. Owner/Applicant Information
Name: JEFFREY LATCHAW D401&BU FER RESOURCES
Mailing Address: 2319 PENNINSULA AVENUE
SHELBY, NC 28150
Telephone Number: 704-300-9990 Fax Number:
E-mail Address: ieff(a)-gualtechindustries.com
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:
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 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: CLEVELAND Nearest Town: SHELBY
Subdivision name or site address (include phase/lot number): 2324 PENNINSULA AVE, SHELBY
NC28150
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included):
2. Describe the existing land use or condition of the site at the time of this application:
RESIDENTIAL WITH SPARCE GRASS TREES AND ERODING SHORELINE
3. Property size (acres): 1.08 ACRES
4. Nearest body of water (stream/river/sound/ocean/lake): MOSS LAKE

5. Describe the purpose of the proposed work: SHORELINE STABILATION USING RIP RAP PER
DETAIL
6. List the type of equipment to be used to construct the project: TRACK HOE & SKIDSTEER
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: 2000 SQUARE FEET
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:
TOTAL DISTURBED AREA 8000 SF
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be
impacted (number of trees for instance): SPARCE GRASS WITH RANDOM TREES. GRASS TO
BE RESOWN ON DAMAGED AREAS
pl� t/ ent's Signature Date
(Agent's gnature is valid only if an authorization letter from the applicant is provided.)

NARRATIVE:
THE SHORE LINE AT THE SUBJECT PROPERTY HAS A WEATHERED ELIZA ETH AVE
ROCS BASE LAYER. THE SOIL LAYER IS ABOUT 2 FEET THICK. THE
WAVE ACTION IS UNDERMINING THE ROOT LAYER OF ANY TREES IN SITE
THE IMMEDIATE PROXIMITY, SOME AREAS ARE AS DEEP AS 3 FEET. DEBBIE
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t DISTURBED AREA ABOVE WATERLEVEL
r a SF
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DEED REFERENCE® 1692 PAGE 299
1 JEFFREY P. LATOHAW
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PARCEL NUMBER: 25530
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