20090763 Ver 1_Shoreline Stabilization_20090710

09-0763
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
Raleigh, NC 27699-1650
1. Applicant Information
I. Owner/Applicant Information
Name: 1. mi<L "Ra4g1e. ?re" Ow
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QCG?G?ONIL??
JUL 1 0 2009
DENR VYETLANDS AND OORMWATER SRAKM
Ro?.c,+ Vaet
Mailing Address: q 0 .?-D 1--0kc R oV c k-
Loo?sb??? ti(_ .2-isy9
Telephone Number: o2S2 q 7 $ L/ / e2l Fax Number: o9S2 q 79 35'9
E-mail Address: t' W Vq (c4ke roVctVC
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:
H. 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: 1:? o.n V J? r Nearest Town: levr% ItI.
Subdivision name or site address (include phase/lot number): La?Cc CZoyg?e
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): Sea- MGc a7
kkrce k ?NyrW16ae_t : b 33 a RE-
2. Describe the existing land use or condition of the site at the time of this application: A, 3. Property size (acres): 35-C) a crtS
4. Nearest body of water (stream/river/sound/ocean/lake):
5. Describe the purpose of the proposed work: ??S? l'l i P T -ho P,ra'ccf'
?w4-x 2losLv,-I ;-I a era _ gr??cca,?
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6. List the type of equipment to be used to construct the project: ho
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: See- Q +aC4? oGu,,yr--
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the noqrmal ool lake level and 50 feet land-ward in square feet or acres:
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for ins/?t'+ance): N c) ti, - 6?? 55 w i ?? yyL_
fi ,D (( l4n ?I t d? A P_ c e S-3 Cir N
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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Site #1:
Location: Site does not have an address but is a greenway beside 1363 Sagamore Drive. See attached
vicinity map.
Impact below normal pool: 84 square feet (28' of shoreline x 3 feet above pool)
Impact above normal pool: 84 square feet (28' of shoreline x 3 feet below pool)
Vegetation to be impacted: NONE (some grass will be replanted where necessary)
Site #2:
Location: 130 Chuckwagon Drive. See attached vicinity map.
Impact below normal pool: 600 square feet (200' of shoreline x 3 feet above pool)
Impact above normal pool: 600 square feet (200' of shoreline x 3 feet below pool)
Vegetation to be impacted: NONE (some grass will be replanted where necessary)
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Site #3:
Location: 138 Bighorn Drive. See attached vicinity map.
Impact below normal pool: 300 square feet (100' of shoreline x 3 feet above pool)
Impact above normal pool: 300 square feet (100' of shoreline x 3 feet below pool)

Vegetation to be impacted: NONE (some grass will be replanted where necessary)
Site #4:
Location: across the street from 278 Sagamore Drive. See attached vicinity map.
Impact below normal pool: 600 square feet (200' of shoreline x 3 feet above pool)
Impact above normal pool: 600 square feet (200' of shoreline x 3 feet below pool)
Vegetation to be impacted: NONE (some grass will be replanted where necessary)