20090559 Ver 1_Application_20090518

. 09 _ 0
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. cannot be used for wetland or stream impacts. Please
provide even 7 co ies 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: for MY CO t"ke
[phone]
i Is. seh d
Division of Water Quality Wetlands Unit Lv�7 to x
1650 Mail Service Center f
Raleigh,NC 27699-1650 ERIC C.ALSMEYER
Regulatory Branch f/
US Army Corps rb A-fr Fee)
of Engineers 6508 Falls of Neuse Road
I. Applicant Information suite 120
Wilmington District Raleigh,NC 27615-6814
1. Owner/Applican��In��formation
rAx (q11)f74-_;8?3
Name: ►"�1�� 1�(.�1,1-Q't' IrECIQS �e��5r scw, �pt'Sicq�—
Mailing Address:_ Q1jyA�1t1,,fS_t J�rr
Telephone Number: Fax Number: +4
E-mail Address: V)V) aU Ll ck f1�0�
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:
D
Telephone Number: Fax Number: MAY i
E-mail Address: DENR-W
ND STORMWATER BRANCH
JL 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
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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: Offgon Nearest Town: (A �°U cc-
Subdivision name or site address (include phase/lot number): 60C
Directions to site please include road numbers, landmarks, etc. (This is not` Aa�us
necessary if an adequate vicinity map is included):
L
2. Describe the existing land use or condition of the site at the time of this
application: P-c S%dPA- ,S / 2 ^ 1 o M C
3. Property size (acres): a a c^es
4. Nearest body of water(stream/river/sound/ocean/lake):OLW,7 L0.k--2--
5. Describe the purpose of the proposed work: Io C,41 ! j kR S 10f eI;n f
r o m 44 e !cr osl on
6. List the t�y�ptp"e of equipment to be used to construct the project: S-AfAdlyd. Jruc%s'
_to Q ✓ / rocAzs 1, -e�
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below//the no al pool Iake leve,( in square feet or acres: w;// e Pslole
4 PeQS 41 ,$' ore AA&.
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) abo e the normal ooI lake level and 50 lee land-ward in
square feet or acres:I-)(N on O sea w a t o a nal a
A PTOAT 1 of
C UJF 4n W a l l
b. Please describe vegetation above the normal pool lake level and 50 feet land- G i�
ward to b im acted (nu berlof trees for instance): a v-P�o 1 ee
1�5 15'ff"O�J owes'
CWO�e ooy�r
Applicant/Agent's ig ature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

5�► � ^` � �a ~ sue' . r,nP 5.
r J Q� �G� ed
SAP s La a (Full Pond) A� k t4l
a4-0 el;u
�Qa
Full Pond
Shoreline
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\a `
—Cr dt
er''So`on
4-o Q
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Please approximately sketch the following information on this Man
(please provide ,dimensions for each item, such as 10 ff. x 100 ft).
1)All proposed vegetation clearing (provide dimensions)
.2) Location of rip rap or fill to be placed.above the Full Pond elevation nl U
3) Location of rip rap or fill to be placed below the Full Pond elevation v Pyera�e�
4) The location of any proposed structures such as buildings, retaining - �e
walls. docks, etc.
5) The location of any excavation or Bridging below the Full Pond Gf'ear��
elevation. �ro
6) Location of construction access corridors. Let Zo
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