20090520 Ver 1_Shoreline Stabilization_20090506

09-0520
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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 Oversight/Express Review Permitting
1650 Mail Service Center D l5@ l5 ow 03
Raleigh, NC 27699-1650 ?5 l5 v
1. Applicant Information MAY U 6 2009
1. Owner/Applicant Information DENR-WATER QUALITY
WETLANDS AND STORMWATER BRANCH
Name: John W Usserv & Patricia Inizram
Mailing Address: 34 Widewater Road
Hilton Head Island. SC 29926
Telephone Number: 843-384-8822 Fax Number: 910-439-6105
E-mail Address: iiordan(@iordanlumber.com (brother)
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 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: ?&4 c a ranee . i Nearest Town: 6: ? [ r4
Subdivision name or site address (include phase/lot number):
1.* A 11, I T' * Z, C3
Directions to site please include road num ers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): Z ?Z 7- C As lk o L,' s
2. Describe the existing land use or condition of the site at the time of this application: 2es . d c ^ ?' a
3. Property size (acres): a -7 V
4. Nearest body of water (stream/river/sound/ocean/lake): A`Fc t : I l e,R /
5. Describe the purpose of the proposed work: .54 a`oc l "z c- S k (s c e 1#`^t
?
6. List the type of equipment to be used to construct the project: Sic c a ya?a r'r%
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
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normal pool lake level in square feet or acres: ?sZ .S here k. ?%t 1C 3
6(ovs _3.5\1 "?,M \-A 1 3S s9 4,C
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 fee land-ward in square feet or acres:
, /
` - SZ 3 k. t 1:"e K C. A`oevr ?.yk` kZ)c,A . ,?--7 / Z
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): Cr-r g- s A-,,\ A p : e x .3
! / e C s
Applicant/ nt's Signature
(Agent's , i ature is valid only if an
// 19
Date
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letter from the applicant is provided.)
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Montgomery Co., NC -- Printable Map
Sale Year: 03
Page 1 of 2
Montgomery Co., NC
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Parcels
Parcel No: 6583 05 29 4551
Parcel Address: 188 BIG OAK
Parcel Owner:
USSERY, JOHN W.
34 WIDEWATER RD
HILTON HEAD IS, SC 29926
Lot Number: LOT 18
Legal Description: LILLY'S BRIDGE DIVISION
Deed Reference: Bk. 494 Pg. 312
Land Area:.35A acres
Year Built: 1957
Building
Value: $48,346
Land
Value: $82,512
Other
Value: $5,484
http://arcims.webgis.netlnc/Montgomery/printable.asp?process=blankmeasure&x2=&y2=... 4/29/2009
Montgomery Co., NC -- Printable Map
Montgomery Co., NC
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Page 1 of 1
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Blg Oak Lri
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Measure
Length: 459 feet
Perimeter: 759.84 feet
Area: 28829 sq. feet
DISCLAIMER: The information contained on this site is furnished by government and private industry sources and is
believed to be accurate but accuracy is not guaranteed. Mapping information is a representation of various data sources
and is not a subsitute for information that would result from an accurate land survey. The information contained hereon
does not replace information that may be obtained by consulting the information's official source. In no event shall
Montgomery County, NC or the consultants of Montgomery County, NC be liable for any damages, direct or consequential,
from the use of the information contained on this site.
http://www.webgis.net Anderson & Associates, Inc. http://www.andassoc.com
http://arcims. webgis.netlnc/Montgomery/printable.asp?process=measure&x2=&y2=&noAt... 4/29/2009
VEGETATE DISTURBED AREA
ABOVE SLOPE
/ EXISTING GRADE
I
l CLASS 1 RIP RAP
2
i
EROSION CONTROL FABRIC----"-
LAKjE
TYPICA CONDITIONS
•12" TO 36" ERODED CUT ,
• WAVE EXPOSURE
FOR: s
LOCATION:
RESERVOIR:
MINOR RIP RAP STABILIZATION
11
DETAIL
2
.

FOR:
LOCATION:
RESERVOIR:
PROJECT.
_TYPICA CONDITIONS
• 12" TO 36" ERODED CUT ,
• WAVE EXPOSURE
DRAWING TITLE:
MINOR RIP RAP STABILIZATION
------------
;ISTING GRADE
4SS 1 RIP RAP
LAKE B07ToM. - -
11/10/99
DETAIL
2