20240220 Ver 1_More Info Received_20240224 (4)

Lake
(At Full Pond/ Normal Water L vel)
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Side View
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Lake
(At Full Pond/ Normal Water Level(
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5.
Describe the exis
ng land use condition oq(the site at the/time of this application (residential,
undeveloped, etc):
;5 i`(L fAt'�Lc2 /
6.
Describe propose
I work (Include discussion as to how hardening of shoreline has been avoided, or
whyitisnecessa
): 5A 'e`t/7'e / S V/fS
od
r
7.
Will work be conc
ucted from land? 34' From water? ❑
g.
Total amount of i
pacts below the normal pool lake level / Normal Water Level
Permanent impa
including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
23-r-
Temporary im
9.
Total amount of ir
ipacts above the normal pool lake level / Normal Water Level and 50 feet land-
ward
Per n�,nt imps
(incl fill, excavation, rip rap, retaining walls, etc.) in square feet:
Juding,back
Temporary
(temporaryclearing, construction corridor) in square feet:
Ty
10.
Please describe th
vegetation above the normal pool lake level/ Normal Water Level and 50 feet
landward to be im
acted (number of trees, for instance):
11. Signature
ey signing below, 1, as the project proponent, certify to the following:
• The project pr ponent hereby certifies that all information contained herein is true, accurate,
and complete to the best of my knowledge and belief
• The project pr ponent hereby requests that the certifying authority review and take action on
this CWA 401 certification request within the applicable reasonable period of time
Owner/Agent`s Si nature' (15A NCAC O2H 05021f11 Date
'Agents signatur is valid only if an authorization letterfrom the owner is provided.
12. Please approximat ly sketch the following information on this plan and provide dimensionsJor
each item:
a. All proposed vegetation clearing
b. Location of ri p rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of ri p rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of ai iy proposed structures such as buildings, retaining walls, docks, etc.
e. Location of airy excavation or dredging below the Full Pond/ Normal Water Level elevation
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