20080429 Ver 1_Shoreline Stabilization_20080307

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The following is an abbreviated application form for those applying for a 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 $200.00 for
impacts of to lake bottom of less than 1 acre and S475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 A1ail Service Center MAR 7
Raleigh, NC 27699-1650 2008
DENR . WATER OUAUTY
WETI ANDS AND STORMWATER BRANCH
1. Applicant Information
i. OvmcriApplicant Information
Name: ego ? r i 3Ti
T:Icphonc Numbcr.._, ?? - jbOZ Fax Number n //?
E-mail Address:_ - -
2. Agent Information to signed and dated copy of the Agent Authorization letter
must be amacbed if the Agent has signatory a-ithority for the ownevapp.Ncant.)
Name:
Company Affiliation:_._
Mailing Address: - -
Telephone Number:
E-mail Address:____
Fax Number:
I1. Project Information
Attach a vicinity map clearly showing the location of the property with respect =.o
local landmarks such as towns, rivers, and roads. Also provide a detailed site
plan showing propeny boundaries and development plans in relation to
surrounding properties. You may use the diagram below to make a hand sketch of
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your project. Also, see the example below for guidnrice. 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 / /
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Counte ? K / P? 4we Nearest Town: l /' (t-
Subdivision name or site address (i lude phasellot number)-- 7-14/1'-7 Cen-,,e 3
Directions to site please include road numbers, landmarks, etc. (This is not /
H I -Y--XtdI2 I?k ez
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necessary if an adequate vicinity map is included): (/,'L t, (.
2. Describe the existing land use or condition of the site at the tinge, of this
annlirminn- Gu,`S /I vi ?i el to "e4'0 6ecc bVC gin,
3. Property size (acres): ?
?fi ?I
4. Nearest body of water (streanJrivedsoundlocearOake): Ake e GV i-I 0?,,_ ®®
5. Describe the purpose of the proposed work: to 40
6. List the type of equipment to be used to construct the project: S?(? d S E?? >r /cam ?7
7. Amount of impact (including all excavation, back-fill, rip rap,
etc.) below the normal pool lake level in square ?Jfeet or acres:
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
square feet or acres: 1-1e- ?x fayP i^? G v, .'HC, G+sc?l( _?yr%? i'ect e-k
b. Please describe vegetation above the normal pool lake level/ and 50 feet land-
ward (o be impacted (number of trees for instance): ?-a S
Ad IZ4
Applica Afts Si'gnaiure Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)