20090436 Ver 1_401 Application_20090416

Office Use Only:
USACE Action ID No.
DWQ No.
Form Version Au ust 2006
09-0436
(If any particular item is not applicable to this project, please enter "Not Applicable" or "w/A".)
Applicant Information
II.
1. Owner/Applicant Information
Name: G v \1 H O .J e_ S
Mailing Address: L kQ `t oyA k-
Telephone Number: 9 50 - 4 -18 - 61009 _ Fax Number:
E-mail Address: A k caw Q-s -,IQ _v,r zz.o. Q G AA to E06
2. Agent/Consultant 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: 71 * r7
Mailin- Address:
b ?a L"
T 209
Telephone Number: Fax Number:
E-mail Address: STORMWATER BRANCH
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. Both the vicinity map and site plan must
include a scale and north arrow. The specific footprints of all buildings, impervious surfaces, or other
facilities must be included. If possible, the maps and plans should include the appropriate USGS
Topographic Quad Map and MRCS Soil Survey with the property boundaries outlined. Plan drawings,
or other maps may be included at the applicant's discretion, so long as the property is clearly defined.
For administrative and distribution purposes, the USACE requires information to be submitted on sheets
no larger than 11 by 17-inch format; however, DWQ may accept paperwork of any size. DWQ prefers
full-size construction drawings rather than a sequential sheet version of the full-size plans. If full-size
plans are reduced to a small scale such that the final version is illegible, the applicant will be informed
that the project has been placed on hold until decipherable maps are provided.
I. Location
County: Frkk r ? Nearest Town: ?
Subdivision name (include phase/lot number): L ci kc TZ6ya-e- L at •&L i 3.p
Site coordinates:
Decimal Degrees (6 digits minimum): 'IN 3:5. 9005"3 a ow - -7 9. X0 Iqy
Directions to site (include road numbers/name landmarks, etc.):
Fc-orn v n L * %4 C kv r k 2ocN1 takk- Sie.ju- 2eia,Aoff. iSt ekiR '14ib mss, le,?A- 10^ LL#S1 e,n,4 br
l3 Sc G.r. ur.. brr..S- ' OC •'[- n .. ?t;. t ct?.., .? ,? "?cl <'a cIt .Sc. M ..n.? .t...e
Page 2 of 4
3. Property size (acres): m L? 0k.C, 4' t 5
LQ kt
?_`tjc, [AL
c
4. Name of nearest named receiving body of water(strearn/river/lake):
5. Describe the purpose of the proposed work:
6. List the type of equipment to be used to construct the project:
7. Type and amount of impact (including all back fill, excavation, riprap, retaining walls, other fill,
etc.) below the normal pool lake level in square feet or acres, and distance from shoreline:
3
8. a. Type and amount of impact (including all clearing, back fill, excavation, riprap, retaining walls,
other fill, etc.) above the normal pool lake level and 50 feet land-ward in square feet or acres:
W 1 ?,+. ? ` _ca ?it n? wry,! ??af
'IR ,rle: NN e d-z l l c.Ai o^ -70'
.D i
b. Please lsc 'be the vegetation above the normal pool lake level and 50 feet land-ward to be
impacted (number of trees for instance): Noso e- -- Gr ss 'rcpic?
?? GSv1 .?c, ?.^ &CLe S< StPYN
W iicant/Ag6es Signature Date '
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 3 of 4
509 Sagamore Dr, Louisburg, NC 27549 - Google 'laps
10 Address 509 Sagamore Dr
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Please approximately sketch the following information on this plan
(pfease provide dimensions for each item, ,such as 10 ft. x 100 ft):
1) All proposed vegetation clearing (provide dimensirns}
.2) Location of rip rap or fill to be placed alcove the Full Fond elevation
3) Location of rip rap or fill to be placed below the Full Pond elevation
4) The location of any proposed structures such as buildings, retaining
vralfsa docks, etc.
5) The location of any excavation or dredging below the Full Pored
elevation.
6) Location of construction access corridors.
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Soil Map-Franklin County, North Carolina
(509 Sagamore Drive soil survey)
35' 59 11"
35° 5T 41"
35' 58' 10'
35' 57'40'
USDA Natural Resources Web Soil Survey 2.1 411212009
? Conservation Service National Cooperative Soil Survey Page 1 of 3
Map Scale: 1.4,350 if printed an A size (S. Tx 11 ") sheet ?
N
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w 0 40 80 160 240
Feet
0 150 300 600 900
TerraServer Image Courtesy of the USGS Page I of I
Send To Printer Back To TerraServer Change to 11x17 Print: Size Show Grid Lines Change to Landscape
ZUSGS 45 km NE of Raleigh, North Carolina, United States 01 Itfi 1978
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Image courtesy of the U.S. Geological Survey
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http://teiTaserver-usa.com/Printlmage.aspx?T=2&S=l I &Z=17&X=1 881&Y=9959&W=l ... 4/12/2009