20091042 Ver 1_Shoreline Stabilization_20091002

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: p ? I D
Division of Water Quality 401 Oversight/Express Review Permitting ?.`•••?.?
1650 Mail Service Center j;
Raleigh, NC 27699-1650 p 9
1. Applicant Information O CT ?, 2009
I . Owner/Applicant Information WETLANDS AND STORE ER ORWH
Name: Pic y A/ /C -<'
Mailing Address: /-i c AF V
Telephone Number: 7C? -?f /f - J Z Fax Number:
E-mail Address: RIV YXC'1,%, d'? ??s?G C Ak' c.?? r?? K^ -
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: ?-')o t? 1 J-\ r (L
Company Affiliation: C_V"J I C`a't- I- ,, '(2-
Mailing Address: l o 5 ? Ili O k. J b -o" It t t I y C???v ?+r?1??
Telephone Number: Fax Number:
E-mail Address: i h ct p e1 eV LJ ,I) C / n; F S ?rLc ?t h Y? ? -
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.
I

Location

County: % Nearest Town: D
Subdivision name or site address (include phase/lot number): T? (R?-?? ,L?? c h/ 130,4,o
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
14 "'J P_w o" c( J-)
vicinity map is included):
P- io
2. Describe the existing land use or condition of the site at the time of this application: ?eL
3. Property size (acres): 1 fL C-
4. Nearest body of water (stream/river/sound/ocean/lake): f1KE _7? Q-Cx
5. Describe the purpose of the proposed work: t E W+
6. List the type of equipment to be used to construct the project: _T_R f c 14 in C
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: 7 5 5
s 5 1/1._
--3--)5-
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:
-57 -3
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): 10 n , N r %-ts $
t/Agent's Signature Date %
signature is valid only if an authorization letter from the applicant is provided.)
awM
North Carolina Department of Cultural Resources
State Historic Preservation Office
Peter B. Sandbeck, Administrator
Beverly Eaves Perdue, Governor Office of Archives and History
Division of I Iistorical Resources
Linda A. Carlisle, Secretary David Brook, Director
Jeffrey J. Crow, Deputy Secretary ER 09-2113
Received August 27, 2009
Due September 11, 2009
NATIONWIDE PERMIT REVIEW
APPLICANT: Roy Chambers
49587 Blackberry Road
Norwood, NC 28128
Project Location: Stanly County
Proposed Project: Soil Disturbance, 59587 Blackberry Road,
Norwood, Lake Tillery
The North Carolina State Historic Preservation Office has received the application for
the above project and our comments are noted below.
Additional information is needed (maps, photographs, other).
J- No comment.
We have reviewed the requested information and have no comment.
Signed« J
??? Renee Gledhill-Earley
` 1 Environmental Review Coordinator
State Historic Preservation Office
4617 Mail Service Center
Raleigh, NC 27699-4617
Phone - 919/807-6579
FAX - 919/807-6599
Date (, I i 1? \)`+
Location: 109 East Jones Street, Raleigh NC 27601 Mailing Address: 4617 Mail Service Center, Raleigh NC 27699-4617 Telephone/Fax: ()19J
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