20231083 Ver 1_More Info Received_20231005 (2)

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5., Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped,, etc.):
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary),.
7. Will work be conducted from land.? [�
8. Total amount of impacts below the no
Permanent
im Cts (including a
rural
From water
pool lake level
excavation,
I�
Temporary impacts in square feet:
/ Normal
a 9
ackfilli rip rap
Water Level
,, retaining wa
lls., etc
� D-
.) in square feet:
i(hfq r&J9-(iecdeA
9. Total amount of impacts above the normal pool lake level Normal Water Level and 50 feet land.
wa rd
Permanent impacts (including back fill, excavation, ri rap, retaining walls, etc.) in square feet: _
�.� D n l�► Zap S�1 6 � I�i,Q rx�uao U-Cc.d
Temporaryi"
10�
m pacts temporaycle3rig, in square feet:
DvL
1 Al.,or a vt Ot.
10. Please describe the vegetation above the normal
landward to be
rniv► I (VkL�
11. Signature
impacted (number of trees, for
5tCACViA
pool I ake [
instance).
b� to�r
9
By signing below, I, as the project proponent,, certify to the following:
14
z0
evel/ Normal Water Leve
�o Iar�L-f-Y.LCs�
e W- OL A VV�
tooffidoffiffio
and 50 feet
VAf UWf& (C4Vr
• The project proponent hereby certifies that all information contained herein is true, accurate,
and complete to the best of my knowledge and belief
• The project proponent hereby requests that the certifying authority review and take action on
this CWA 401 certification request within the applicable reasonable period of time
C--aol I AA A
Owner/Agent's Sign ture' [15A NCAC 02H .0502(f)1 Date
'Agent's signature is valid only ifan authorization letter from the owner is provided.
12, Please approximately sketch the following information on this plan and provide dimensions for
each item:
a.. All proposed vegetation clearing
North Carohna De artment of EnvirorYmental QLxahty I Division of Witter Relsources
1-02 Noah Salisbury street 1 1617 Md. 11 Service Center I Raleigh,, North Carohna 27()99-1617
19 707..9000

t L i
im /
Full Pond/ Normal Water Level
ro reFi n e
ft. x 150 ft.
additional clearing
Plan View
i
if
Lake
(At Full Pond) Normal Water bevel)
-0
Riprap
Existing Dock
f 34ftx7 F:
3x150 f
Below full panda NWL
41
Above full parid! NWt
M.
.� Ninth Carol ina Depilment of' Environmental Ouality I Divisionol'W.merResources
512 NorihStreel I Salisbury 1617 Mai! Service Center I Ralcigh, NoFth Carollwa 27699-1617
919 707.9000

4%
Full
b, location of rip rap or fill to be placed above the Fu
C. Location of rip rap or fill to be placed below the Fu
11 Pond/ Normal Water Level elevation
II Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings,, retaining walls,, docks, etc..
es Location of any excavation or dredging below the full Pond/ Normal Water Level elevation
V
Pond/Normal Water Leve
Shoreline
Plan
v�
e w
Lake
(At Full Pond/ Normal Water Level)
I roeeo' ;114;erd 0 -: �*.- A
5rvra�l 4
5h r�1 hs
as
Kb 0 VED
r
FVWO--O)( 1COOMOT, N 6
f�n�G�SS TO
PXTff Vi lk
tA M IQ f2o fio
4A'a North Carol ina Department ofEnvrronmenti-d Quality I Division of Water Resourcc:s
512 Norlh Safiskff)' Street 1617 Mail Service Center E i�, lcigl�, NorIh Uhfirohn,3 2709.16 1.=1
919-707 9000