20090393 Ver 1_Application_20090409

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The following is an abbreviated application form for those applying for a 401r
Quality Certification to impact FERC (Federal Energy Regulatory CommisAik-,
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regulated lake shore or bottom under the U.S. Army Corps of Engineers Perm
GP30. This Application cannot be used for wetland or stream impacts. Please .r
S cop u.D provide °"•?'?r "-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 $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality
Wetlands/401 Unit
2321 Crabtree Blvd Ste 250
Raleigh NC 27604
1. Applicant Information
1. Owner/Applicant Information
t I f
Mailing Address:
Telephone Number: 917- 3 N 9 -,f9,?9 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: Gt4. cA 13Rnu, o
Company Affiliation:
Mailing Address: Su I CH BHOWN CONSTRUCTION
104 E)OGWOOD LANE
SIT G11- E_- 'A h J G 274n6
Telephone Number:
E-mail Address: L k
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.
1. Location _
County: l ?P8 ei " j e' . f i Nearest Town: &J J .
Subdivision name or site address (inclide phase/lot number): L!r& KAAa# . L p?
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included): Sp P In A.P
Describe the existing land use or condi 'on of the site at the time of this
L' ye /r lhF'N r fee 14 7 C
application: ,e ; r )Z` WT/
3. Property size (acres): f ?1 N
4. Nearest body of water (stream/river/sound/ocean/lake): e )A 14r
5. Describe the purpose of the proposed work: Cf M,7-fi v r 1;'r,,q LA -,q re1 5,F,e ihk I
to P
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6. List the type of equipment to be used to construct the project:
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres: 7 t4 - 1` 7*-,bel o wl
(.0,47-f `r 1;14,0
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: PT C` ' A i 1"i ; ^? . I C
f'" T I IT fi ti p A 0 ,, ro . P i? r?, 41 _r"
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): r? F E S Ja'r
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
BUTCH BROWN CONSTRUCTION
104 DOGWOOD LANE
MT. GILEAD NC 27306
PHONE [phone]
Lake (Full Pond)
Full Pond
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Please approximately sketch the Mowing Worma n on this plan
(please provide dimensions for each Item, such as 10 ft. x 100 ft).*
1) All proposed vegetation cleaning (provide dimensions)
.21 Location of rip rap or fill to be placed above the Full Pond elevation
3) Location of rip rap or fill to be planed below the P Pond elevation
4) The location of any proposed st ctures such as buildings, retaining
walls, docks, etc.
v) The location of any excavation or € dging below the Pull Pond
elevation.
ill Location of construction access corridors.
---- J r. r
1 of 1
Brown's Construction
104 Dogwood Lane
Mt Gilead N.C. 27306
910-439-1384
3-18-09
I Ellis Hankins give Butch Brown of Brown's Construction my permission
to Act as my agent in securing permission, permits and construction of my
boathouse. The location of construction is #o.be 324 Ea Sant F3oad, Ll/aod
run Development. Tfe".C
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Date .z '710
ilis Hankins

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. LEGEND
PROPERTY LINE
°- •-- - °? LINE NOT SURVEYED
FENCE LINE LAKE TILLERY
POWER UNE PROC EMMY
T m
SIR f FIR
Fc9
sms { ERRS
D.t:I.Q.
N,C O.S.
RCP
RET
TEL1rPHONE LINE
CENTERLINE
RIGHT OF WAY
SET FOUND IRON PIPE
SET FOUND IRON ROD
SET j FOUND CONCRETE MONUMENT
SET j FOUND RAILROAD SPIKE
DOUBLE MERIDIAN DISTANCE
NORTH CAROLINA GEODETIC SURVEY
RMNFORCED CONCRETE PIPE
RETAINING
PIER E+? !
?f1?O
h
WALL
v
WAALLL rWALL
1
DOTES PROGRESS ENERGY
PROPERTY CAPPED FIR
1. ALL DISTANCES SHOWN ARE HORIZONTAL MEASUREMENTS.
2. NO NCGS MONUMENTS WERE FOUND WITHIN 2006 OF THIS PROPERTY. ? EMY PROGRESS
3. TITS MAP IS NOT PREPARED FOR RECORDATION AS PER G.S. 47--30.
4. ZONING INFORMATION, IF SHOWN, IS AS PROVIDED BY THE MONTGOMERY f
COUNTY INSPECTIONS DEPARTMENT.
5. THIS SURVEY 15 SUBJECT M ANY FACTS THAT MAY BE DISCLOSED
BY A FULL TITLE SEARCH
S. THIS PROPERTY IS SERVICED BY UNDERGROUND UTILITIES.
NORTH CAROLINA
I, TERRY M. DENNIS JR., CERTIFY THAT THIS MAP WAS DRAWN
UNDER MY SUPERVISION FROM AN ACTUAL FIELD SURVEY CONDUCTS
UNDER MY SUPERVISION AND IS TRUE AND CORRECT TO THE BEST
MY KNOWLEDGE, THAT THE PROPERTY LINES SHOWN ARE BASED UP
AN ACTUAL FIELD SURVEY UNLESS OTHERWISE NOTED HEREON. THE
9ATION OF PRECISION AS CALCULATED IS 1;10,000-, SOURCE OF
TITLE FOR THE PROPERTY SURVEYED IS DEED BOOK 330, PAGE
287, MONTGOMERY COUNTY REGISTER OF DEEDS.
VITNESS MY ORIGINAL SIGNATURE. REGISTRATION NUMBER AND SEAL
THIS 1ST DAY OF DECEMBER, 2005.
LAND SURVEYOR
L-424.2
a t
2 2-
S 2- 4
REGIS7ATION NUMBER
n j 1910 WEST MAIN STREET
-- A POST OFFICE BOX 1733
ALBEMARLE, NC 28001 L and
PHONE [phone]
FAY [phone]

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COPYRIGHT @ 2005, DENNIS LAND sURVE11NG,, INCORPORATED.
ALL RIGHTS RE-9MVM. REPRODUCTION OR USIE OF THE CONTENTS
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OF THIS DOCUMENT, OR AODITiQN$ OR OE1.gT10NS TO THIS
DOCUkVIENT, 94 VMO1E OR IN PART, YATHOUT WRMM CON^SW 0
OF DENNIS LAND SURVEYING, 15 STRICTLY PROHIBITED. ONLY a
CONIES FROM THE ORIC(NAL OF THIS DOWAIENT. AS APPROVED BY
THE SURVEYOR SHALL BE CONSIOERED TO BE VALID, TRUE COPIES. I!
PROGRESS E
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PROFEF¢TY
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BUTCH BROWN CONSTRUCTION
104 DOGWOOD LANE
MT. GILEAD NC 27306
PHONE [phone].
711
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