20150565 Ver 1_Shoreline Stabilization_20150609

20150565
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The following is an abbreviated application form for those applying for a401 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 Wat QtMt 101 $240.00
for impacts of to lake bottom of less than 1 acre and $570.00 for impacts to I e)bottroAofjgreater
or equal to 1 acre.
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Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review
1650 Mail Service Center
Raleigh, NC 27699 -1650
I.
'1.
2.
Applicant Information
Owner /Applicant Information
Name:
Mailing Address
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Telephone Number: q11 - �/b� 1-'�`_f J Fax Number: 1
E -mail Address: L�G Ft � % Lt b 6_01 - I 1 co/n
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:
E -mail Address:
II. Project Information
Fax Number:
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: PC- k_5 d M Nearest Town:
Subdivision name or site address (include phase/lot number):
lugs- GotJ C-O to cl4,)2cl�aL
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:
3. Property size (acres): -2, �k I A-
4. Nearest body of water ( stream /river /sound/ocean/lake): LAND
Describe the purpose of the proposed work: &LIA1 N / N Gi ,51-0 U L IN A-U_
6. List the type of equipment to be used to construct the project: A l /✓ CA-V1b f_ 1 Sk O 3Z�
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: 3-ao 5 F
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:
YRD 5E
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance):
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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Please app mAmafely sketch the fogowing information on this plan
lease provide dhoerkslans for each item, such as 10 ft. x IN ft):
1) M proposed vegetation chWng (provide dimonsions)
A Lotion of rip rap or fill to be placed above the FuR Pond elevation
3) Location of rip rap or fill to be placed below the pull Pond elevation
d) The locatlan of airy' p osed otrectum such as buildings, retaining)
wagsp docks, etc.
6) The location of any excavation or edging below Ow pull Pond
elevation.
gj Location of construction access corridors.
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Pleeee approximately sketch the folowing information on this plan
(pleam provide dhmnrslons fw each Stem, such as 10 ft. x 100 ft):
9) AA proposed veW tion clearing (provide dlntendme)
A Location of rip rap or fill to he placed above the FsA fond eleMlon
9) Location of rip rap or fill to be placed below the FUN Pond elevation
4) The location of mW proposed sbvdu s eu-h as buildings, retaining
wagso docks, elm.
6) the location of any excavation or edging below On Full pond
elevation.
g) LooMm of icon 0ruc#imn access corridors.
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