20240404 Ver 1_More info recieved (2)

5. Describe the existing land use or condition of the site at the time of this application (residential,
undeveloped, etc.): _arC,,n ::t �f ��� �tiT�r _ nyt-P-
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is neces,5,�ry):
�p QaI' �v� ll ke(�✓ N .ero�'�
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7. Will work be conducted from land? From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
l %L sr- Lf�
Temporary impacts in square feet:
_-6'
Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet land-
ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction corridor) in square feet:
-24a F sr Zon w_ -t / 96S' of- 4:�-e
2&n.c 2 A; D se Fe.
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 feet
landward to be impacted (number of trees, for instance): "fo ( 7('.ccsk7i % "fv 9"
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11. Signature
By signing below, I, as the project proponent, certify to the following:
• 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
G � 2 0-2 o
caner/Agent's Signature` (15A NCAC 02H .0502(fl) Date
Agent's signature is valid only if an 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
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d_ Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
��� North Carolina Department of Environmental Quality I Division of Water Resources
D_E512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
u�src �r iM»w� 919.707.9000

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12. Please approximately sketch the following information on this plan and provide dirfiensions fop
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal Water,Level
Shoreline
Plan View
Lake
(At Full Pond/ Normal Water Level)
Lake
(At Full Pond/ NOmt;!Water Letup Existing Dock
/30frx7ft
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1
3 ftx350ft 1
0e!rnvful pond/ N\NL
Full Pond/ Normal Water Level
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- Shoreline-- aexlsoft
Riprap Abam full pond/NWL II
Z ft. x 150 it. I
additional cGaring
if reczzsary
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I Plan View
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FORS: SSGP 02-2017 Page 3 of 4