20051868 Ver 1_Complete File_20050106

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The following is an abbreviated application form for those appiving for a 401 Water
Qoahty Certification to impact FFRC (Federal Energy Regulatory Commissio??t )
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 seven M copies of this application and supporting information as well as a
non-refundable application fee to tb.e Division of Water Quality of $200.0 for
impacts of to lake bottom of less than I 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 Unit
1650 .Mail Service Center
Raleigh, NC 27699-1650
I. Applicant Information
a[9@[ffiV1A1
OCT 6 2005
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
1 Owner/Applicant( nfi?rm1 ation
Mailing Address:,

Telephone: Number:_ Fax Numben ____
E-mail Address:
Agent Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agcnt has s}'gnatory authority fOT the owner/applicant,
-N --- - - -- ---- - -
Companv Affiliatiozz 1y(ar?.? ` C'?,• ?? ? 4 U f
Mailing Address Uri"-._
- - - ---
(?.C
1
?t° FaxNumbez:-----.__-------
Telephone Number: _a2?t ?r`)S 30
E-mail Address:_ m_Qr 4? ecAv
11. Project Information
Attach a vicinity map clca.rly showing the location of the property with respect to
local landmarks ditch qs 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
{-P- 1 f tl- Vlr F f l-1! : C)lJi? -I JFTL HI JI
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your project. Also. sec the example below for 6Tuidance 80tli the vicinity Map and
site plan must include it wr-do aid north arrow. The footprints of all buildings.
impervious surfaces, or other facilities must he included,
Location
3 Nearest `I own:_ l
County:-
name nr site address {include phase/lot number) i r5-rr? --- -- ---
Subdivision
Directions to site please include road numbers, landmarks, etc (This is not
necessary if ail adnuate, viginiV map is included): -- - -
8
2. Describe the existin land use or condition of the site at the time of this
application:

r't ?.

2 v
_ ?, 11
'

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Proparty size (acres)?_._..___._-- ------
4. Nearest body of water (stream/river/sound/ocean/lake):
?. Describe the purpose, of the proposed work:S,k?
6. List the type/of requipment to be used to construct the project: (:Ci.l/ c+_??
CJle t c 54e,
-- - ----- - ---._..-
7. Amount of impact (including all excavation., backfrll, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres, --- -_Q_ - - __-_-_-_-
a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the normal pool lake level and 5,0 feet land-ward in
___3
square feet or acres:
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): i r e r ? -A U n :(c r-. S
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from
hate
applicant is provided 1
^EP-14-2085 06:13 FROM:DWI-WETLANDS 91.97336893 TO:918264953050 P:3 5
Arf??1 (I?r,
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Pim" aWe?x mffAe y sketch. the fob We.rma*m an #46 Ma O
Ueaee proem* nMons for each ftm; such as IQ ft, x 184 fly.
1) AD Prapowd we"Won ~rig ( ?+do dbne . . I .
2) Loaaffivra of rip rap or 1111 !o be pined arb+a+, v the FOO Por elegatba?n
3) Locarfim of rip rap oai fill to be placed bel+aw? fhe 1W Pond eleva Wn
4) TIN b"Mon of pay ?o"O *mcbmw wch as buffcgng , mWnlra
S) The hmmAlvn of arrry ema lore or dr ing ba r Ow Ft* Pond
IelanrWan.
6) 1. OF aWWrVdim ra mmm cor re.
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Start: SR-127, Hickory, NC 28601
End: 43rd Avenue Dr NW, Hickory, NC 28601
http://mappoint.msn.coml(s 1 acm545xitsh5 jcie31mhi3)ldirections.aspx?&StartName=SR-127... 9/26/05
MSN Maps & Directions - Directions Results Page 2 of 2

Total Distance: 3.5 Miles
Estimated Total Time: 10 minutes
Directions Miles Map
stat-t: Depart SR-127, Hickory, NC 28601 on 13th Ave NE 0.2 F
(East)
1: Turn LEFT (North-West) onto SR-127 [2nd St NE] 0.3
2: Bear RIGHT (North) onto SR-127 [N Center St] 2.8 F
3: Turn LEFT (North-West) onto 42nd Avenue Dr NW 0.2 (?
4: Turn RIGHT (North-East) onto 1st Street Dr NW 0.1
Arrive 43rd Avenue Dr NW, Hickory, NC 28601 1st Street
127
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The folloiving is an abbreviated application form for those applying for a 40l Watts
Quality Cerfifir_ation to impart FERC (Federal ?,nergy Regulatory ComwissiOlt )
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 seven (7) copies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $200.0 for
impacts of to lake bottom of less than I acre and $475.00 for impacts to lake bottoms
of greater or equal to 1 acre.
Applientions should be sent to.
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
QM c?P. oeP=?
OCT 6 2005
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
1. Applicant Information

a
Owner/Applicant formation
Name: , Mailing Address._ -- ---t? J ?? `Sf
----
---
.--------
Telephone Nunzbcr:_
E-mail Address:_
Agent Information. (A signed and dated copy of the Agent Authorization letter
must be attached if the Agcnt has s gnatory authority for the owner/applicant, )
Name /err n Cam.. `-??
Company Affilzatiozz: ?? i f
Mailing Address' S ?_ yr or
Telephone Number:_a11 .30?t k-: F Number:__.
E-mail Address :___Jy1-9 r .•1 c Q,1 1, 6) e0 r tF11 , 11 . n }
11. 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 properti",. You may use the diagram below to make a hand sketch of
Fax Number:
-?? t o-i? qtr.. i ?. 1 i? I; C)l??i=i•IFT! NtJI'= =+1' ???r,H'74

Your proIect. Also, see the exwnple below COT s;uada.nce $otl_i the vicinity reap and
site plan must in.cludc; 0 9crile arx3 north- arrow. The footpriaits of all buildings
impervious surfaces, or citber facilities must be included.
I LocatIOn
County l c? _ -`
e orite address t.ziclude pha e,,/lot nUtnber) rat rte` .?
Subdivision. ream (
Directions to Qite please include road. numbers, landmarks, etc (This is not
necessary if a ad uate vi .nit Map is includedY --
?n
2. Describe the existin land use or condition of the site at the time of this
application:
-- -
'
Prop crty size (acres)
4. Nearest body of water (staeam/river/soundJocean/lake): 17L
7. Describe the purpose of the proposed work:
6. I ist the type of /e/quipment to be used to construct the project: h.4 <->
Sic J t; r
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in Square feet or
>3. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc. i above the normal pool lake level and 5,0 feet land-ward in
square
1 n` e(ct o ?r acres:-- 3 b. Please describe vegetation above the normal, pool lake level and 50 feet land-
ward to be impacted (number of trees for imtance):
AppIicwtJAgent's Signature Date
(Agent's signature is valid only if an authorization letter from teapplicant is provided )
FP-14-FOO5 06:13 FROM: DI4Q-WETLANDS 91.9733689.'_, T0: 916284953050 P: 3'5)

C+(r P. ?? t ? ? 1(

p1me a oxbm9e4y sketch the fad WormMun an 6* plan
Ueaoe provide nsions for each Iftm; such as 10 ft, x 190 0
1) All proposed taltn a no (pmv$do dimneWw)
2) L?oaaL of rip nip or fill to be pined above the FuM PoW sle lan
3) Locam of rip rap or fill to be placed below this FW Pond eleaaWn
4) 111 !at*Oon of xW V possO e4mchmes a-wh as lyuikNnq% r+ WnirQ
dQ, oft..
5) The locatl an of mW o awndiarp. or d ri?dong bdow. dw F Pond
alevoon,
6) Logall m of candmebm +e,atc coat em
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b?eNtloPoirri
Start: SR-127, Hickory, NC 28601
End: 43rd Avenue Dr NW, Hickory, NC 28601
http://mappoint.msn.coml(s 1 acm545xitsh5jcie3lmhi3)ldirections.aspx?&StartName=SR-127... 9/26/05
MSN Maps & Directions - Directions Results Page 2 of 2
Total Distance: 3.5 Miles
Estimated Total Time: 10 minutes
Directions Miles Map
Stab: Depart SR-127, Hickory, NC 28601 on 13th Ave NE 0.2
(East)
1: Turn LEFT (North-West) onto SR-127 [2nd St NE) 03
2: Bear RIGHT (North) onto SR-127 [N Center St] 2.8 F
3: Turn LEFT (North-West) onto 42nd Avenue Dr NW, 0.2 F
4: Turn RIGHT (North-East) onto 1st Street Dr NW 0.1
Arrive 43rd Avenue Dr NW, Hickory, NC 28601 tst Street
127'.
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Make it easy for others to find your locations
Learn how to link to MSN Maps & Directions from your Web site.
Learn how to display your store locations on your corporate Web site.
t4czerw I Mir rvTSra ; Hotmail j 5shopping i Money I People Ft Chat , Search
2005 hii? ro=Uit i of poiation. All rights resorsed. l crr, _,t Usc, Niveitise NISN f rivacy Statement GetNeMse Anti-Spam Policy
http://mappoint.msn.com/(sl acm545xitsh5jcie3lmhi3)/directions.aspx?&StartName=SR-127... 9/26/05
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