20190365 Ver 1_Shoreline Stabilization_20190320

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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 seven (7) copies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $;.A"O 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
1. Owner/Ap
Name:
'20,90366
Telephone Number:
E-mail Address:
2. Agent fort:
must agnacl
Name:
Company
Mailing A
G (A signed and dated copy of the Agent Authorization letter
if the Agent has signatory authority for the owner/applicant.)
Telephone Number:
E-mail Address:
Fax Number:
Il. 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

s
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: Nearest Town: -
Subdivision name or site address (include phase/lot number):
Directions to site please include road numbers, landmarks, etc. his is not
necessary if an adequate vicinity map is included):
2. Describe the
ing I d se or co�ldition of the site at the time f this
3. Property size (acres):
4. Nearest body of water (stream/river/sound/oceair/lake):—P-A"
5. Descri the urpose of the proposed work:
V'i ata_
6. List the�type Pf equipri ent to be of ed to construct thT prop
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres: 4_f : `���-�—
<ZU'l , I QSXI
8. a. Amount of -impact (inehiding all clearing, back_ fill, excavation, rip rap,
retaining walls, etc.) abo a th normal pool lake level and 50 feet land -ward in
square feet or acres:
b. Please describe vegetation above the normal pool lake level and 5Q feet land-�
ward to by impacted (ryumber of trees -for instance):
- I & Pw
�2) rJ
Applic a ignature Dae
(Agent' sign is valid only if an authorization letter from the applicant is provided.)

PleaseaWrox! matety sketeft thefollowing arm, aWn on ftsi Ion
Aa provido onerralarisfor each item, such as M ft. x 100 ft)-,.I =01 iproposed vagetatiort Ob ft (provide dins enWons-)
Lofun of rip rap Or fill: to bwpfaced ab ave th-v FOU Iron 'O +t Levi
Location of rip rap or fill to be: placed below, the Pitt Pond elevation
The focatlart ofany OrOpo'sed sftuctures such, as buildings, retaining.
vnff%;docks, etc.
l
\-/6) The Inationof arW exuavallort or dridging below Ifie Fulf Pand
IW. an.
6) eWCOM of icanstra
uctlan corridor
t

To:
FRED BAIRD BLACKLEY, ASLA
LANDSCAPE ARCHITECT
--- 504 SOUTH DEKALB STREET
SHELBY, NORTH CAROLINA 28150
[phone]
Transmittal
Attn:
t kPro ject :
Project No:
Date: �. �'L �' c.
Copies
Item
Description
For: APPROVAL INFORMATION RECORD REQUEST REVIEW COMMENT USE
Remarks:
Copy To: By:
"L�t
Via: US MAIL AIRBORNE_— PICK UP UPS FAX HAND DELIVER OTHER

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