20080351 Ver 1_Application_20080227

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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 $289:9~for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to lake bottom -_J
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
I. Applicant Information
~°~~~~~
w1 f
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I~'e7~4NDS AND STUR~ANlg7ER'BFZANCH
Owner/Applicant I ~
Name:
Mailing Address:
Telephone Number: ~ 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:
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
plan showing property boundaries and development plans in relation to
surrounding properties. You may use the diagram below to make a hand sketch of

US Army Corps O[ Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell Union
US Amry Corps of Engineers Avery Clay Jackson Polk Watauga
I51 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
NC 28801-5006
Asheville Cabamu Graham Madison Stanley
,
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Duriranr Johnstrnr Roekinghartt Wilson
US Awry Corps Of Engineers Alleghany Fdgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Sorry
Suite 120 Caswell Forsyth Northampton Vance
NC 27615
Raleigh Chatham Granville Orange Wake
,
Telephone: [phone] Davidson Guilford Person Warren
Fax: (9l9) 876-5283 Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Cusituck Jones Pitt
US Aany Caaps Of Engineers Bertie Dare
G Lenoir
Martin Tyrrell
Washington
Post Office Box 1000
Washington, NC 27889-1000 ates
Camden
Carteret` Green Panilico Wayne
Telephone: {282)975-1616 Chowan Hertford
Craven Hyde Pasquotank
Peignimanc
`Cr+oatan National Forest Only
Fax: [phone]
Wilmington Regulatory FieM Office Anson ~ Duplin Onslow
US Amty Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Bnmswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: (910) 251~S1 l Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
US Fish and Wildlife Service /National Ma rine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
NC 28516
Beaufort
Raleigh, NC 27636-3726
4520 Asheville, NC 28801
Telephone: [phone] ,
Telephone: [phone]
Telephone: (919) 886-
North Carolina State Age ncies
Division of Water Quality Division of Water Quality State Historic Preservation Office
401 Wetlands Unit Wetlands Restoration Program Department Of Cultural Resources
1650 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
NC 27699-1650
Raleigh Raleigh, NC 27699-1619 Raleigh, NC 27699-4617
,
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan HeRford Pasquotank
1638 Mail Service Center Bertie
Brrmswick Craven
Cunituck Hyde Pender
New Hanover Perq~~~mans
Raleigh, NC 27699-1638
Telephone: (9l9) 733-2293 Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kenrersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Sorry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Gra}ranr Madison Transylvania
Fax:'[phone] Haywood McDowell Yancey

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.
Location ~~~
County. Nearest Town: e ~
Subdivision name or sit ddress (include phase/lot number):
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included):
2. Describe the a fisting 1 d use or condition of the i
application: .~ ~ ~~
at the time of this
3. Property size (acres): ~ GiC
4. Nearest body of water (stream/river/sound/ocean/lake): (~~t~,,/~`~ `
5. Describe the purpose of the proposed work:_`'~ _~~l/ec~ ~ ;~~1c~eli>,. c~.-i
~x r
~ i~ ~ ~es'ea~~pp -'
6. List the type of equipment to be used to construct the project: ~~ ~ fSe~ ~~~
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres: /~G~'IP
8. a. Amount of impact (including
retaining walls, etc.) above the no
square feet or acres: M '
all clearing, back fill, excavation, rip rap,
mal cool lake level and 50 feet land-ward in
b. Please describe vegetation above the normal pool lake leve and 50 felt land-
ward to be impacted (number of trees for instance): nGt~e ~ ~Ca~1~

A~licant/Agent's Signature l Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

c
4~
Please approximately sketch the fa~awing information an t#us-plan
(please provide dtrnensions far each item, such as'f0 ft. x 1Q0 (t~:
1) AI( proposed vegetatic-n clearing (provide dimensians~. Imo!
2~ Location of rip rap ar fill to be placed abate the Fug Rand ~elevatlon '~
3) l.acatian of rip rap ar fill to be placed below the Fud Rand elevation /
4~ The location of any pr ;a-~d stctures such as s}uildingg, retaining
walls, docks, etc. • ~~7C~C C~1 yy.
5) The location of any excavation ar wedging below the Full Rand
ell'vatlOn.
6) Location of cans ruction BCCess corridors.

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'9608 WINDT GAP ROAD
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