20071934 Ver 1_Shoreline Stabilization_20071115

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OT-1934
The following is an abbreviated application form for those applying fora 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 seven (7) copies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $200.0(1 for
impacts of to lake bottom of less than 1 acre and 5475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
.~.
o! $ `"'
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;~± J ~~ ~ :y 2407
I. Applicant Information
Owner/Applicant Information
Name: ~~c-~~~~ VVl ~v, -r ct.~
Mailing Address: ~~ i Z7 {= I
~1F~.,1r1~;a :=~~c~ T~"^~!"!.o;;~R. ~RAP!CH
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Telephone Number: 7U ~ - y SC 7=L'~.2 3 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:
Company Affiliation:
Mailing Address:T
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
plain 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: C 1 C v E ~ Ca ~ c~ Nearest Town: 5_ h e (~ ,:~ C-
Subdivision name or site address (include phase/lot number)• C 1 ~ nL ~~ t 2
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included): ~~y -~-~ ~. v ;~.J c~ `f

2. Describe the existing land use or condition of the site the time of this
application: (Z ~ 5 ~ ~te-~~ r c~~ ~ l~C C.Y P,G ~u n c~~ l ~-~ L ~~r ~5 tir
3. Property size (acres): ~ C,C c r' [ ±~
4. Nearest body of water (stream/river/sound/ocean/lake): I~Y~uS.s ~~ ~C
5. Describe the purpose of the proposed work: r< ,, ,1(J ._ ~ c~4 ~ S ~~ v e. I ~ yl ~ `~.= ~'
6. List the type of equipment to be used to construct the project: [~~~ ~, c c~`~
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres:!' ! ~ r U.aD
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
squaze feet or acres: I Z S ~ ~,~-{ r ~ ~n fcun - ~ -~~~~ ~~~ ~ c{~o r
b. Please describe vegetation above the normal pool lake level and 50 feet land-
wazd to be impacted (number of trees for instance): 11~ y ~l-V'F.~? S ca .y t ~ % ~~.~C ~
Applicant/Agent's
(Agent's signature
_/~- ._~
Date
valid only if an authorization letter from the applicant is provided.)

Lake (Fuf1 Pond)
Full P~and
Sharet~ne
~_-~ ~ ~ X25'
}-- rv-~.~--
bus
5~G 5~-~C P1~~~~~~h?c~
~Yuv ~ c:~ ~ C~ L y
C -Y ~1 e ~- ~ pe~w~~~.i-.
~~ ~
S~ei~ ~"l~~'` ~L~Qun~Ll/l~ ROrY1~
Please approxirnateiy sketfih the fallowing Irrf~ormation an this plan
~ptease previde ditr-ensfens f+~ each item, such as 10 ft. x 1011 tt):
1 ~ AIt propose~# vegetation clearing provide dimensions)
~) Location of rip rap er fill to be placed above the Fuil Pond elevation
3) Lotatic-n of rip rap +or fill to be placed below the ~utl Pond elevation
~~ The location of a~ proposed structuros such a*~ buildings regaining
walla. docks, etc.
3~ The location of any excavation ar dredging below the Full Pand
elevation.
~) Location of crnstructiah access ~cnrridors.

51
take Full Pond)
Full Pond
St~r~r~elin+E
.*
Please approximately sketch the fa~owing ~iarmatian on this plan
(please provide c~mensians far each item, such as 1 D ft, x 1 ~ ft):
i ~ ~11t propos$d xegetation clearing (pro~ride dirnen~sion3)
~) Location of rip rap ar fill to lie placed above the Foil Pond elevation
3) Location of rip rap ar fill to tie placed below the Full Pond elevation
4) The Ioc,atior~ of any proposed str~ct~rea such ~-~ buildiagsF retaining
walls. docker etc.
3~ The location of any excavation ar dredging below tfie Fuli Pond
elevation.
X61 Lvcatior~ Qf cat~~tructior~ access corridors.

Cleveland Co., NC
N
DISCILAIMER: The information contained on this site is famished by government and private industry sources and
believed to be accurate but accuracy is not guaranteed. Mapping information is a representation of various data sou
and is not a subsitute for information that would result from an accurate land survey. The information contained her.
does not replace information that may be obtained by consulting the information's official source. In no event sha
Cleveland County, NC or the consultants of Cleveland County, NC be liable for any damages, direct or consequent
from the use of the information contained on this site.
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