20080202 Ver 1_Application_20080129

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JAN 2 9 Z.OQ8
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EC 12-t3
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t'HAI2LEJT1'F., NC 29~O1-li}l1G
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APPLICA"Ii(}N FCJR PER?~lIT Tt} STAB}LIfE 7'FfI. ~Iit}R.F.Lf~tE I'ti ~C}Ri'H C~1Itt)L1\~
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SC€B>iTI ~.PPLICATION AND r~PRt}PRIAi'E Dt KE EhE12G1" FILLtiG FEE, PAl'?+BI.k. TC} Dl_ ItiF EtiFRGi`.
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JAN 2 9 2008
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1)t ELI: IItiI•;RGI' llIRFCTIONS BY ROAD FOR?~I
1, tke L,'u Penurt Attplicants and Contracto~~ ;~tse of locatinK the proposed project site cyan have a hid
itit('~i~t on tk~rrnit prc~:cs~in~ tune.. Please complete this form and return it along nth your completed
t~rtnit applicati~?n to
DUKI~ 1h`LRGI'
CIO LAKE SER~ZCES - EC 12 Q
PO [3O~ 1006
CIi.~KLO"I'TE, NC 2201-1006
I-8110-44.3-5193 pr Option S
'~Pplirant~s iv'anie -1 t(~ ~J~_~~~~'
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Ln6e Nanic ~'~ '~ ~/E'
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Subdivision N;]O1C: _ _ `~ _~e'~_ ~.~~ ,' Wr ~.,~ / ~
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Propert}' Section- ~'~~~-~---~ ~_~ L,ot df ---l--L~'~
City: -1~- t~'tt%,~ 1 ------- County: _ ~~ ;!~_~~~J
State: - /~ L_ Zi ~~ 1 ~--
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Telephone -- ~t.;~ ~j ~ - t'`t';j
Directions (from ruajor road or high~yay):
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Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile home; etc):
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`Note: Please ase fhe bact: of this farm if desired to draFV us a map tv the sites
~?aI,~L,AYEtifGh'[-C/Parkage [nfoaitiaioa/DUZCiions by Road Form do^
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~u i ~ - tioogle Maps Page 1 of 1
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' "'~' Address r`=~~.,~,fc i~c:.~ !~~`~~fr~'; ^~_'' ~~~~ Notes I-85 South exit 27. South on 273 to
~ , ~ ~~ Belmont, NC 28012 left on South Point Rd. Right into
Reflection Pointe subdivision. Left
on Lake Point Drive, lot 110 on left.
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The folloNing is an abbreviated application form for those applyiag 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.~T) copies of this application and supporting information as well as a .,,.
aoo-refundable application fee to the Division of Water Quality of S`#~:00` for ~ fJ"-
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: O 8 r ~ !~ O 2
Division of ~i'ater Quality Wetlands Uait
1650 Mail Service Center
Raleigh, NC 27699-1650
[. Applicant Information
~PAIID
1. Owtter/Applicant Information ~~Q~
Name: I (~ V t (~ Q
Mailing Address:
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Telcphone Numbcr:_ O Fax Num er-._ _ - _
E-mail Address: _ rII~VEf}R~/-~' ~°1iN/+. RR. LDe'L1 -.- ----- __-_---_--
Agent Infomation (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the ownecapplicant.}
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Nantc: .~ %A -
Company Affiliation:, _- R ~ ' __.__--
Mailing Address: ------
Telephone Numbcr:~~~7~~~Fax Number: - U _-.---
E-mail Address:
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[[. Project Information
,Attach a vicinity map clearly showinc the location of the propem with respect to
local landmarks such as towns, rivers, and roads. Also provide a detailed site
plan showing pmpcrty boundaries and development plans in relation to
surrounding pmlx rtics. You may use the diagram below to make a tnutd sketch of
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your project. Also, see the example below for guidance. Both the vicinity trap and
site plan must include a scale and north arrow. The footprints of all buildings,
impervious surfaces, or other facilities must be included.
Location /
County. '~ A ~ / ~~ Nearest Town: !? (~1.D~
Subdivision name or site address (include phase/lot number):_~p/tLTt6K t~.•~+s ~ oT//O
Directions to site please include road numbers, landtttarks, etc. (This is not
necessary ifan adequate vicinity map is included}: .~-ff~S To eri~ 27 ~ Itno.~i ~NT'/,~o/,
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2. Describe the existing land, u$e or condition of the site at the time of this
application: rlk[ZJ+~-I ~ l~ui 11~~0 1~t-
3. Property size (acres): ~ ~~ ~ /}C2e
4. Nearest body of water (stream/river/sound/occart9rlake}: ~/} F-e ~r~~re-
5. Describe the purpose of the proposed work: r f't Ji4~ ~~k- ~y~ SiN9~t ~~yi+'' ~ ~y ~Jo/~'~'
6. List rho. npc of equipment to be used to construct the project:___._~AC ~ ~tve + ~ 6 [°.~T
'. Amount of impact (including all excavation, backfill, rip rap, retaining walls, ~
etc.) below the nomtal pool lake level in square feet or acres: bt? Sc~u/iJtP -~~(
rs. a. Amount of impact (including all clearing, back fill, excavation, rip rap.
retaining walls, etc.) above the normal pool lake level and SU feet land-ward in
square feet or acres:_ -g~~~_.~-_._-_-- __-~ --
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to th. impacted (number of trees for instance):_$ - /~ 7Ru5 AT l4 ke C~~Ce Du
Appltcant/Agcnt's Stgnaturc Datc
(Agent's signature is valid only i rization letter from the applicant is provided.)

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Please approximately sketch the fopowing information on this plan
(please provide dimensions for each kem, such as 10 ft z 100 ft}:
i}All proposed vegetation Bearing (provide d'unensions)
2) Location of rip rap or f01 to be placed abore the Fug Pond elevatlon
3} Location of rip rap or fdl to be placed below the Full Pand elevation
4} The tocatlon of any proposed structures such as buildings, retalning
wails, docfcs, etc.
5} The location of any excavation or dredging bebw the Fup Pond
elevation.
6) Location of construction access corridors.

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?8012 -Google Maps
Page 1 of 1
''"~+ Address i=~~l I<<~ r~~'J t?' ~'"'j~` ~` ~ ~~~~ Notes I-85 South exit 27. South on 273 to
~ left on South Point Rd. Right into
~~ ~;~ Belmont, NC 28012 Reflection Pointe subdivision. Left
on Lake Point Drive, lot 110 on left.
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