20150792 Ver 1_Shoreline Stabilization_20150805

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: PAIW
Division of Water Quality 401 Oversight/Express Review Permitting 1650 Mail Service Center D
Raleigh, NC 27699 -1650
I. Applicant Information
1. Owner /Applicant Information
Name: Nl 1 M t
Mailing Address: 74f Al. c1 �`{�a f -�c�r� 9d,
W i n.(forn - sa l ev►), N(, ,X710'4
Telephone Number: 3 alp — y 13-f / Lt f Fax Number:
E -mail Address: i l') I m i SG O t f31 al o. Lorv,
' AU•G 0 � �Oi5
DENR - WATER RESOURCES
401 & BUFFER PERMITTING
<0150
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: /� I eV Qh OQIZ Nearest Town: &fib► lc h'Gm
Subdivision name or site address (include phase /lot number): -7o LOOP EX f
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): tPU. VeV t'ne tt4eGt'd
i
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): o, �� 1q('geS

4. Nearest body of water (stream/river /sound /ocean/lake): Ld*6,
5. Describe the purpose of the proposed work: /''P,plduv <52!� !. All
6. List the type of equipment to be used to construct the project:
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: %&-MO tab Old f(' Q, &V6111 Ad
replQW 1,04-h vt_Li1 462, Wd4
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:
Y�inrmct�
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted (number
of trees for instance): Gj Yass
! v NW' c 6 ,0-14t ­
Applicant/Agent's Signature Date "'
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Aaron and Mimi Scott
70 Lakeside Loop Ext
NEEDED Repairs and Upgrades to the Lake House:
j Remove old sea wall
Replace sea wall
Fixed boardwalk over water 4'by36'
Fixed boardwalk over land 4'by36'
Covered Area/patio 8'by16'
Replace all decking on,existing dock
a
New � i
soD
coy �
f X � Ova 4►/ i;-
4 O VITA
u -�OAVI J¢E�1-
t) b& U vC445

DBC DOCKS Estimate
75 Puffer View Ln
Maiden, NC 28650
Scott'Mimi
70 Lakeside loop
Hickory NC
04 332
-8R8.,00'
Totil
u n ity
a t
C os
-f4bta
01 Plans and Plans and Permits
1
1,400.00
1,400.00
Permits
Fixed Pier w/ Fixed pier w/Pvc 8x36
288
25.00
7,200.00
Pvc
Roof w/metal Roof w/metal 8x16
128
16.00
2,048.00
02 Site Work Wood retaining wall
1
4,000.00
4,000.00
02.10 Demo Demo old wall
1
800.00
800.00
Deck pvc decking on walkway and float
1
5,000.00
5,000.00
02 Site Work Add joist to make 16" oc.
1
700.00
700.00
02.10 Demo Demo old decking
1
750.00
750.00
-8R8.,00'
Totil

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ty Map
Lake Hickory
Scale
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wife
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Address
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