20190679 Ver 1_Shoreline Stabilization_20190520

RPILACKLEY, ASLA
AADSCAPE ARCHITECT
04 .�P{�iii.�EMtALB STREET
ELBY, NORTH CAROLINA 28150
[phone]
Transmittal
6
To: Attn:
6k4jf(M WA* Wtject:
Project No:YAW JP41A aA- LtC� fb Date:
Copies
Item
Description
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For: APPROVA INFORMATION RECORD REQUEST REVIEW COMMENT USE
Remarks:
Copy To: T� By:
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Via: US MAIL L" AIRBORNE__ PICK UP UPS FAX HAND DELIVER OTHER

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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 $300 ftO for 2`t 0
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:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
I. Applicant Information
1. Owner/Applica I f
Name:
Mailing Address:
2.
Telephone Number:
E-mail Address:
Agent Information (A signed
must be attached if the Agent 1
Name:
Company Affiliation:
Mailing Address:
Telephone
E-mail Ad
er:
II. Project Information
&( LOLW .
Fax Number:
dated copy of the Agent Authorization letter
signatory authority for the owner/applicant.)
Fax Number:
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: Nearest Town: l
Subdivision name or site address (include phase/lot number):
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included): Z ^ter--
FWA
2. Describe the exi9sltingI land use �o condition of th site at he time time of
application:
3. Property size (acres
4. Nearest body of water (stream/river/sound/ocean/lake):�
5. D
6. List the type of equipment to be us7d to construct the project: INA r"YN
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake leln square f or acres:
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above
�' the normal pool lake level and 50 feet land -ward in
square feet or acres: I Y b�cD t `Mil c n �_ 1 o
b. Please describe vegetation above the normal pool lake level and 50 feet and-
ward;o be impacted (number of trees for instance):
AA 12d At
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Full Pend
heline
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Please approximately sketch the following information on this plan
(please provide chmensions for each item, such as 10 ft. x'100 ft):
1) All proposed venetation clearing (provide dimensions)
2) Location of #�fanly
air fill to be placed above the Full Pond elevation
Location of or fill to be placed velour the Full Pond elevation
Thelocation proposedstructures such as buildings, retaining
walls, docks, etc.
/k/The location of any excavation or dredging below the Full Pond
elevation.
6) Location of construction access corridors.

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