20080875 Ver 1_Application_20080527

PAYMENT FRED BAIRD BLACKLEY ASLA
LANDSCAPE ARCHITECT

P-
PECEI?`..
:
504 S DEKALB
SHELBY,ONORTH CAROLINAE2 150
[phone]
Transmittal
08._°875
g@gae[?
MAY 2 7 2008
DEW - WATER QUAUTY
To: ?L Attn:
ICI Project:
650- Project No:
?!Le -C /L Date:
? 1 D? a ?1

Copies Item Description
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For: APPROVAL INFORMATION RECORD REQUEST REVIEW COMMENT USE
Remarks:
Copy To: _ ?_o By:
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Via: US MAIL ?Q AIRBORNE_'_, PICK UP UPS FAX HAND DELIVER OTHER
P (' 90+
48-0875
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 Y .
non-refundable application fee to the Division of Water Quality of $211WM-Tor ?-[ v • do
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
1. Applicant Information
1. Owner/Applicant Informati9n /
i Name: I?d-V y4
Mailing Address:
J 464W ! e b?
Telephone Number: ?0 t/ - 481 qa `
E-mail Address: C row e. J I rh
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
W1"a
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MAY 2 7 2008
DENR - WATER QUAUI'1
WETLANDS AND STORMWATER BRANCH
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Fax Number:
6/1,AK. net"
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: UWA" -Nearest Town: wau -biu
Subdivision name or site address (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 e g land u le or condition oft ite at the im of this
application: istin UWALVO? LVN
3. Property size (acres): --7 1Jd L Gf1Yv? S'?y?,G
4. Nearest body of water (stream/river/sound/ocean/lake): AA,,O SS
5. Describe the purpose of the proposed work: ?J) 5?-r-U2r7\,O 6J"
e why fl, : I 1 V\L
6. List =X f equip ent to be,used to construct the project: J''LL ? kcr- f 1k
eq,) ip W`92 -
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres: II(C;t, -2, ' -
8. a. Amount of impact (including all
retaining walls, etc.) ab. the normal
square feet or acres: _ ?4-- L L S
clearing, back fill, excavation, rip rap,
pool lake level and 50 feet land-ward in
b. Please describe vegetation above the normal pool lak level and 50 feet land-
ward to be impacted number of trees for instance):
lti d W
A?plicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Lake (Full Pond)
Full Pond
Shoreline
4-
Please approximately sketch the f ing information on this plan
(please pride ditnenaione for each Item, such as 10 ft. x 100 t) -
-1) AN proposed vegetation clean (provide dimensions) /-T
/ ) Location of rip rap or fill to be placed above the Full Pend elevation
/ 3) Location of rip rap or fill to be planed below the F Pond elevation
1`t location of my proposed strictures h buildings, retaining
flee, etc.
? ) The ration of any excavation or In below the Hull P` nd u «
elevation. `Q&j PC[--O'P
?6) Location construction access orridors.
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