20151062 Ver 1_Application_20151013

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 time 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 Mater Quality of $240.00
for impacts to flake bottom of less than 1 acre and $590.00 for impacts to lake bottom of greater or
equal to 1 acre. P
2
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting Q 1650 Mail Mail Service Center
Raleigh, NC 27699 -1650 OCT 1 3
1. Applicant Information DEMP �, _.. 2 ©15
Owner /Applicant Information
Name: _ ., i © r P°
Mailing Address:
Telephone Number: �� 3� �� '� Fax Number:
E -mail Address:
10
62
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: G f (' „ "�O "Vi.�r,
Mailing Address:
'telephone Number: � k5"��i%�— i j f�� Fax Number:
E-mail Address: Ce. (A 610, ("rl car -,<+ u i t u � C � /4L41' 1 . r
11. Project lmmforg�tion
Attach a vicinity snap clearly showing the location of the property with respect to local landmarks such
as towns, rovers, 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: LCACI (. ")kO_ Nearest Town: '
Subdivision name or site address (include phase/lot number):���
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequa e
vicinity map is included): 4f�n r1 o _L 6 .
2. Describe the existing lands use or condition of the site at the time of this application:' , es \ Ae et Cam.
3. Property size (acres): a
4. Nearest body of water (stream/river /sound/ocean/lake):
5. Describe the purpose of the proposed work:
6. List the type of equipment to be used to construct the project: �7��CC I - �rm .� Jvcx -
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: 1 �Jc% U c s GO 1 c-41
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:
Pooz Q,a�,& IA tO
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance):
-z"Y" CI Appli ;ant/Agent's Sign e Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Please approximatelY -sketch the following information on this plan
(please provide dimensions for each item, such as 10 ft. x 100 ft):
i) All proposed vegetation clearing (provide dimensions).
2) Location of rep rap or fill to be placed above the Pug Pond elevation
3) Location of rip rap or fill to be placed below the Fu® 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.

Print - Maps
bing Maps
A Mooresville, NC
B 8441 Babe Dr, Terrell, NC 28682
Route: 10.9 mi, 21 min
Page 1 of 1
My Notes
On the go? Use m.bingxam to find maps,
directions, businesses, and more
A
Mooresville, NC
A—B:: 10.9 mi
21 min I
1.
Depart W McLelland Ave toward S Academy St
0.9 mi
2.
Bear left onto NC -150
Pass Hess in 2.4 mi
8.3 mi
j
h
3.
Turn left onto Kiser Island Rd
1.4 mi
4.
Turn right onto Babe Dr
0.3 mi
B
5.
Arrive at 8441 Babe Dr, Terrell, NC 28682
The last intersection is Yellowbell Dr
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 D 2015 NA\rrEQTM
http://www.bing.com/mapslprint.aspx?mkt=en-us&z=12&s=r&cp=3 5.590899,-80.891973... 9/30/2015

CATA"A Geospatial
_— Information Services
Real Estate Search
N
w+r
S
Parcel: 461703412122, 8441 BABE DR TERRELL, 28682
Owners: BARLOW HILDA JO A, DIAMONT FRANCES J
Owner Address: 518 S ANDY GRIFFITH PKWY
Values - Building(s): $133,900, Land: $213,900, Total: $347,800
1 in=100ft
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
09/30/2015

CATAWBA Geospatial
Information Services
'�j
Real Estate Search
N
W E
5
Parcel: 461703412122, 8441 BABE DR TERRELL, 28682
Owners: BARLOW HILDA JO A, DIAMONT FRANCES J
Owner Address: 518 S ANDY GRIFFITH PKWY
Values - Building(s): $133,900, Land: $213,900, Total: $347,800
1 in=400ft
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
09/30/2015

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