20171214 Ver 1_Shoreline Stabilization_20170925

2 0 1 7 1 2 1 4
The following is an abbreviated application form for those applying for a 401 mater Quality
Certification to impact FERC (Federal Energy Regulatory Commission) regulated lak
bottom under the U- .,S. Army Corps of ii ngineers Pea aoit Gi'30. 'l'liis Application cannot be used e shore or
for wetland or strew impacts. Please provide five () copies of this application and supporting
information as well as a non-refundable application fee to the Division of Water Quality of $240.00
for impacts to lake bottom Of less than 1 acre and $570.00 for impacts to lake bottom of greater or
eeual to a acre.
Applications should he sent to:
DIVIsion of Water Quality 401 ht/ OversigXP
1650 iilail Service Centerress review Permitting
Raleigh, NC 27699-1650
�
a• AppLcant Wormatior "FP 2 201
A R RE
1. Owner/Applicant information F R P RMITT S
Name: e r
Mailing Address:a.
Telephone Number: 1�.2 r? � 10�
Bax Number:
E-mail Address: �C� n Gee r' M �I A ,�-, �• a► —i�, , '✓�
J
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: _-I Gr1'�."
Company AffiIiation:
Mailing Address:
�U 7
Telephone dumber: a•
1 Fax Number:
E-mail Address: rt c.�-� /i �:,4 . i, iI Z -A
H. Project hi orrnatlon
Attach a vicinity mai 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 boun
hand daries and
development plans in relation to surrounding properties. You may use the diagram below to make a
sltetch of 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 aII buildings, impervious surface
facilities must be included. s, or other

I. Location
County. kr- 9 d � Nearest Town:
Subdivision name or site address (include phase/lot number): 3')% $ 5 (o (o , OW
Directions to site please include road numbers landmarks,etc. 6�
s not necessary if an adequate
(T'his i
vicinity map is included): �� �n '-1, ,,�
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): J I k
4. Nearest body of water (stream/river/sound/ocean/lake):
5. Describe the purpose of the proposed work: _
- �1r1 14-v..e
6. List the type of equipment to be used to construct the project: Wo C4+ , L vv% t. i j,
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: 4 n , , P I- L
—�-,
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
abovea normal pool l e level and 50 feet land -ward in square feet or acres:
T2,-, <,, r _ .
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): 1(101
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

3c ummnsions tor eaen Rem, such as 10 M x IOC
-d ven"on dearina fisravide &vnmmAms'k
J" FW "W OF MI 110 00 PUMOO SDOVO Me Fag Pond-elevatk
)f rIP rap or M to be PlaAmd below the - Fun Pond PlavAtin
I
Lpi i sm aum excavamon nr fWWnnIrMT hMACUM ftsm Mail M
!itriULI Lail lsl W—#

Lip bing ..
A Mooresville
B 122 Rockhaven Dr, Statesville, NC 28625
A Mooresville
47 min, 33.0 mi
Light traffic (39 min without traffic)
Via 1-77 N, 1-40 W
B 122 Rockhaven Dr, Statesville, NC 28625
These directions are subject to the Microsoft% Service Agreement and are for informational purposes only. No guarantee ismade regarding their completeness or accuracy.
Construction projects, traffic, or other events may cause actual conditions to differ from these results. Map and traffic data © 2017 HERE'.
Depart W McLelland Ave toward S Academy St
0.9 mi
2
Bear left onto NC -150
1.8 mi
Take ramp right for 1-77 North toward Statesville
©
3
Pass Days Inn on the right in 0.1 mi
15.3 mi, 13 min
♦ Minor Congestion
4
At exit 51 S, take ramp right for 1-40 West toward Hickory
11.8 mi, 11 min
5
At exit 141, take ramp right and follow signs for Sharon School Rd
0.1 mi
Turn right onto Sharon School Rd, and then immediately turn left
1.4 mi
6•
onto Walnut Tree Rd
7
Turn left onto Lookout Dam Rd
1.0 mi
j�
8
Turn right onto Island Ford Rd
0.6 mi
F1
9
Turn left onto Rockhaven Dr
361 ft
Arrive at Rockhaven Dr
10.
The last intersection is Island Ford Rd
j
B 122 Rockhaven Dr, Statesville, NC 28625
These directions are subject to the Microsoft% Service Agreement and are for informational purposes only. No guarantee ismade regarding their completeness or accuracy.
Construction projects, traffic, or other events may cause actual conditions to differ from these results. Map and traffic data © 2017 HERE'.

Iredell County
Property Data
Parcel Number: 3783285566.000
Inquiry Date: 9/8/2017
Disclaimer: While every effort is made to keep information provided over the internet accurate and up-to-date, the County does not
certify the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping
data herein, or for their use or interpretation by the User.
Property Map
Owner/Property Info
Tax Account Number: 80039287
Old Parcel Number: 1408Q000OOA002
Owner Name: VANDERMOLEN CALVIN J+JULIE L
Mailing Address: 122 ROCKHAVEN RD STATESVILLE NC 28625
Property Location: ROCK HAVEN DR
Lot Number: Null
Legal Description: LAKE LOOKOUT SR1006
Municipal Information
Township Code: 14
City Code: 00
Neighborhood Code: 14000
Value Information - Current Year Property Record Card (PRC)
Building Value: 136230
Other Building Features: 19970
Land Value: 92390
Tax Assessed Value: 248590
Deferred: 0
Land Information - Register of Deeds Online Search
Date Recorded Document Type Deed Book Deed Page Plat Book & Page Land Area Land Type Zoning

4WCONNECTGI'S.
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Iredell
Printed September 08, 2017
See Below for Disclaimer
Addresses
Infrastructure
' NonResidential Use
' Residential Use
Streets
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Ramp
US Hwy
State H% -,y
Main Road
Local Road
Residential
Private
Inactive
Parcels Hooks
Parcels
City Limits
".
1 : 185 Feet
f S
The maps prepared for this website are generated from recorded deeds, plats, and other public records. Users of these maps are hereby notified that the information
rovided herein should be verified. Iredell County assumes no legal responsibilities for any of the information contained on this site. Users are advised that the use of an
f this information is at their own risk. All maps on this site were prepared using a 10005E- Grid based upon the North Carolina State Plane Coordinate System from the
1983 North American Datum. The delinquent real property tax overlay is updated monthly. The information presented is not intended to be used or relied upon as official
notice of tax liens. For additional information regarding delinquent taxes, contact the Iredell County Tax Collector's Office.