20150668 Ver 1_Application_20150709

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 - 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: ���'(. 1>�ltc�,Gr ��i op
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Mailing Address: P,A ve_ aP `P _e,
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Telephone Number: 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: CIen"_ �ec)e e_� to
Company Affiliation: '_N�P, ne ci.� Clvas� r-u� ki o N
Mailing Address: i, b a a sJ Y�' c?� J � sd C �yn oer K -, V63
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Telephone Number:a Fax Number:
E -mail Address: er-r vnS4 rL r -lc>►\ cP arn C, i C C, vr\
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: ( PNN n (A )V)a . Nearest Town:
Subdivision name or site address (include phase/lot number): SO (O ova 6 r r- 0 5 6J
G
Directions to site please include road numbers, landmarks, etc. (This is o�'Aeces if(3 adequate
vicinity map is included): S -2c- C-) 4 c ,-4- oc1.
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): ..574
4. Nearest body of water (stream/river /sound/ocean/lake): N Ofmar,
5. Describe the purpose of the proposed work: rS 7_ �Q. � VN ore i n 2
r CAP (h II -.. _ (aC G I A
6. List the type of equipment to be used to construct the project: eXra,OCA -c-)c 5k; d eel
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: -� e I () 5
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:
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): f1 uh o ,
Applicant%Agent's SignaE'ure Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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Please approximately sketch the following information on this plan
(please provide dimensions for each Item, such as 10 ft x 100 ft):
1) All proposed vegetation clearing (provide dimensions).
2) Location of rip rap or fill to be placed above the Fuit Pond elevation
3) Location of rip rap or fill to be placed below the Full Pond elevation
4) The location of any proposed structures such as buildings, retaining
walls, docks, etc.
5) The location of any excavation or dredging below the Full Pond
elevation.
6) Location of construction access corridors.
1 �1

Print - Maps
LV bing Maps
A Mooresville, NC
5065 Mallard Cove, Sherrills Ford, NC 28673
Route: 13.7 mi, 27 min
My Notes
On the go? Use m.bW9.em to find --a
jifections. busr, s and rr*re
Page I of I
A Mooresville, NC A—B: 13.7 mi
27 min
1. Depart W McLelland Ave toward S Academy St 0.9 mi
2 Bear left onto NC-150 9.9 mi
Pass QuikTrip in 2.8 mi
41 3. Turn left onto Slanting Bridge Rd 2.0 mi
4) 4. Turn left onto Keistlers Store Rd 0.2 mi
4) 5. Turn left onto Barkley Rd 0.4 mi
41 6. Turn left onto Mallard Cove 0.1 mi
B 7. Arrive at 5065 Mallard Cove, Sherrills Ford, NC 28673
The last intersection is Carolyn Circle
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 0 2015 NAVTEQTM
http://Www.bing.comlmapslprint.aspx?mkt--en-us&z--12&s=r&cp=35.579258,-80.903359... 6/21/2015

CATAWBA Geospatial
_­ . I% — Information Services
Real Estate Search
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Parcel: 461603034202, 5065 MALLARD COVE SHERRILLS FORD, 28673
Owners: BISHOP CHRISTOPHER CLARK, BISHOP SHANNON BATCHELOR
Owner Address- 2026 BELVEDERE AVE
Values - Building(s): $54,600, Land: $266,200, Total: $320,800
This map /report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map /report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map /report product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
06/21/2015
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Parcel: 461603034202, 5065 MALLARD COVE SHERRILLS FORD, 28673
Owners: BISHOP CHRISTOPHER CLARK, BISHOP SHANNON BATCHELOR
Owner Address- 2026 BELVEDERE AVE
Values - Building(s): $54,600, Land: $266,200, Total: $320,800
This map /report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map /report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map /report product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
06/21/2015

CATAWBA Geospatial
�� ■:r - Information Services
Real Estate Search
W �nN
E Se t 5 n 0 I U Y1G� e v/ CJ Yl � A-
S
J
Parcel: 461603034202, 5065 MALLARD COVE SHERRILLS FORD, 28673
Owners: BISHOP CHRISTOPHER CLARK, BISHOP SHANNON BATCHELOR
Owner Address: 2026 BELVEDERE AVE
Values - Building(s): $54,600, Land: $266,200, Total: $320,800
1 in =150ft
This map /report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map /report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map /report product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
06/21/2015

PA
20160668
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Jul, 0 9