20090001 Ver 1_Shoreline Stabilization_20081229

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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 five (5) 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
equal to 1 acre.

Applications should be sent to:

Division of Water Quality 401 OversightJExpress Review Permitting
1650 Mail Service Center
Raleigh, NC 27699-1650

I. Applicant Information

I. Owner/Applicant Information

Name: I-Af2...~Y t-- DA W ^J K A- ~
Mailing Address: I a 6 &. II m BE"' e L- A t:::...F: C T
M.:t- Gr I (~Il (' Q J N c. ~ 7 3 () l

Telephone Number:
E-mail Address:

q/ D ... Y 31 - q;;2.. q (p Fax Number: q I 0 . if 31-
JaUJh J. e ,,/ It.J ~ ~()O, (2.-()h---)

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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:
E-mail Address:

Fax Number:

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 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"

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DEe 2 9 2008

D9IR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH

1. Location

County: \\\ () NT G-<.'i '€ Nearest Town:
Subdivision name or site address (i clude phase/lot number): I OJ l{ II M &----;~ l-IH:.(S (~ 1-
Directions to site please include road numbers, landmarks, etc. (Th" is Jar (;c'J;art tt an adequate
vicinity map is included): fS+-o,.--vu J-ZD c6-b..-> 21/. 7- W b~-'- SOf..-i {H (r€P
7~ 56 q-r J..l I (Y1,1e. tv L.,'f. S (gel e . I ~ /2-i- -
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Describe the existing Ian use or condition of the site at the time of this application:
Property size (acr~s): .. L{ Co ti-C-~ ~:..A..t .
4. Nearest body of water (streamlriver/sound/oceanllake): l-A kG --=rt LivE Kr
5. Describe the purpose of the proposed work: S €. cq 1?-€ . s/''L~~ i~.->
~c~ref ~ ~ ~.t4~

6. List the type of equipment to be used to construct the project:~ C k: f-\ a l:~
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square reet or acres: 3. o.v s ~ ~

8.a" Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal po lake level and 50 feet land-ward in square feet or acres:
~ 0 ...:!U;;

8.b. Please describe vegetation above tbe no~al pool lake level and 50 reet lan~ to be impacted
(number 91 trees for instance): '3 t1--e e - <:L, l.~ * ~ .
/h1- &.-Q..1 tJ1 &tA'-e 'l_ ~/ ,rn.() /1I...e~_ r~h ~ ..
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;~ ~&tl~_ /::1 ;.2;J.l?~ R

ppli anti: gent's Sign ure Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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VEGETATE DISTURBED AREA
ABOVE SLOPE .

EROSION CONTROL FABRIC-----

_ ~f: ;Y E~STING GRADE

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LAkE BOTToM --

TYPICAL CONDITIONS
. 12" TO 36" ERODED CUT
. WAVE EXPOSURE

RESERVOIR: Li\t:F
PROJECT;

11/10/99
FOR, L,; ( f<. ' k)l / Il1 1H1 E ,<:/)S/ 0 IV C (J en L 7- R... E: PAl R
LOCATION: L bl I'l S'Lt'/FT 7SLA/VO' / qil T /IYJ f3Erz.. L-Ak'c C_I I
IVlT c~ I L~e- AD I Nc
1.. 7.30 f.,

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II CLE:.R.Y
5fjOQ.E REPAfe

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ORA WING TITLE:

MINOR RIP RAP STABILIZATION

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Mount Gilead, N Carolina - Google Maps

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Address Mount Gilead, N Carolina

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