20040680 Ver 1_COMPLETE FILE_20040427

!;~rtl.ficate of Completion

nWQ Project No.:

County:

'F\OLUPrN

-(>tf- OfpflO__

~e r!..[ Iv r: DS0l5

F1rojectName: VA-170N CJ~ELj'll2:..-1I1 .j)
;;>EfJtjLE />0//'11 W/968, ../
Date of Issuance of 401 Water Quality Cei4ification:!1/fJ: y~

Applicant:

A!ZJef) U9~E-
I'll d. 001

'-'

Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and
any subsequent modifications, the applicant is required to return this certificate to the 401!\l/etlands Unit,
North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form
may be returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is
not necessary to send certificates from all of these.

Applicant's Certification

T_e.eU~ r L SW/6 , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be
built within substantial compliance an mt nt of the 401 Water Quality Certification and Buffer Rules, the
approved plans d specifications, 0 r supporting materials.

, ~). Date:~Aff /CJ5
I /

Signature:

Agent's Certification

I, , hereby state that, to the best of my abilities, due care and
cHigence was used in the observation of the construction such that the construction was observed to be
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.

S'gnature:

Date:

If this project was designed by a Certified Professional

I, , as a dilly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weeldy, full time) the construction of the project, for the Permittee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to be buill within substantial compliance and intent of the 401 V/ater Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.

Signature:

Regip~m~

MAl< 0 9 2005

Date:

DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH

o'f \N A r~1t
O~ Oc..
(;; 7
- \
> -
- -i
o "'\

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources

Alan W. Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality

Mr. and Mrs. Cecil Lewis
4503 St. Andrews Drive
Wilson, North Carolina 27896

WETLANDS J 401 GROUP
MAY 2 /) 2004

May 19, 2004
DWQ# 04-0680
Rowan County

WATER QUALITY SECTION

Subject Property: Pebble Point, Phase I, Lot #19

APPROVAL of 401 Water Quality Certification with Additional Conditions

Dear Mr. and Mrs. Lewis:

You have our approval, in accordance with the attached conditions and those listed below, to
excavate (dredge) approximately 90 cubic yards of sediment and install approximately 135 linear feet of
riprap along the shoreline of High Rock Lake, as described in your application received on April 27,
2004. After reviewing your application, we have determined that this project is covered by Water
Quality General Certification Number 3373, which can be viewed on our web site at
http://h20.enr.state.nc.us/ncwetlands. The General Certification allows you to use the U.S. Army Corps
of Engineers (USACOE) Regional Permit No. 198200030 when issued. Please note that you should
get any other federal, state or local permits before proceeding with your project, including those
required by (but not limited' to) Sediment and Erosion Control, Non-Discharge, and Water Supply
Watershed regulations. .

The above noted Certification will expire when the associated USACOE's 404 permit expires
unless otherwise specified in the General Certification. This approval is only valid for the purpose and
design that you described in your application. If you change your project, you must notify us in writing,
and you may be required to send us a new application for a new certification. If the property is sold, the
new owner must be given a copy of the Certification and approval letter; and is thereby responsible for
complying with all conditions.

For this approval to be valid, you must follow the conditions listed in the attached Certification,
as well as the additional conditions listed below:

1. No dredging shall occur within 15 feet of the full pond elevation as staked in the field.

2. All dredged materials shall be disposed of in an appropriate upland location and not allowed to
discharge to High Rock Lake.

3. Upon completion of the project, the applicant/responsible party shall complete and return the
enclosed "Certificate of Completion" form to the Division of Water Quality's 401/Wetlands Unit.

N~jmCarolina
/Valufall!!

.1.1
NCrleil

N. C. Division of Water Quality, 40 1 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (hno:l/h2o.enr.state.nc. uslncwetlands)
Customer Service #: 1-877-623-6748

Page 2

If you do not accept any of the conditions of this certification, you may ask for an adjudicatory
hearing. You must act within 60 days of the date that you receive this letter. To ask for a hearing, send
a written petition (that conforms to Chapter 1508 of the North Carolina General Statutes) t~ the Office
of Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and
its conditions are final and binding unless you ask for a hearing.

This letter completes the review of the Division of Water Quality under Section 401 of the Clean
Water Act. If you have any questions, please telephone Polly Lespinasse in the Mooresville Regional
Office at 704-663-1699 or Cyndi Karoly in the Central Office in Raleigh at 919-733-9721.

Sincerely,

D f24~

Alan W. Klimek, P.E.

AJ/aj

Attachments

cc: Corps of Engineers Asheville Regulatory Field Office
Wetlands Unit- Cyndi Karoly
Central Files
File Copy

"

_040680

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 $200.00 for
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

WETlANDS 1401 GROUP
APR 2 7 2004
WATER QUALITY SECTION

I. Applicant Information

1. O~er/ Applicant Information $ '., L €. ::n.
. =g~r1;.~:L15:1b3't/: .:5tj2?J-,r(/)/lf"u.f IJ~~~. L.
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Telephone Number~5 07 - ..;:{ 3 t..J - Cf'ltJ'I Fax Number:
E-mail Address:

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:
E-mail Address:

Fax Number:

n. 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

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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:~{')wAN Nearest Town: 0A~,l5 B~
Subdivision name or site address (include phase/lot numberQ->E ~ L- E- ,-
Directions to site please include road numbers, landmarks, etc. (This is not :.p H- A S E j
necessary if an adequate vicinity map is included): J..-OT -tll '1

J nl1'P r N eLL. LLcb~ b

2. Describe the existing land use or condition of the site at the time of this
application:Ll-tlJ)~\le l-O()€n l:t~~~~u..,1 Lb I ~-=' i..>O'f:-
) "C>T ~ TA E<2JS --.t- JL__~T1 br-i ..... ---=>1le.f.\ E aJ..~"
rsO. "TA,E.cS O~ \feqF111Tl O~ C)N APt~A TO Bee.
<e...KCA vATE..D - $ f7N '-Dq., 9 D lL- I I'J A A E P),
3. Property size (acres): II 4lt ~

4. Nearest body of water (stream/river/sound/oceanllake):

.~

6. List the type of equipment to be Used to construct the projectS ~ 0 N.T f: tJ D
LDAJ)~A""'-~lA.c..,~. .. '
. c..vl" ,OLLA E1..cy JlltO,J. tA..1fi...t.. ~t;. ~~A \J RT;e,t
7. Amount of impact (including all excavation, backfill, rip rap, rJ:iinnf.:a~ e> - , "i3 '.,
etc.) below the normal pool lake level in square feet or acres: ~ ~ d$
Cp:.;: '. 'oen 00, f;.:
.Q. J::T, ;.1) e e.p. D ,q 't I N q W l.l-- ~ 1)0 flJt. <50 W ATe:~ WI (,.L [)Ill\ I ~ , "'T'O
8. a. Amount of rmpact (including all clearing, back fill, excavation, rip r~p, M~"~lC>E~
retaining walls, etc.) above the normal pool lake level and 50 feet land-ward,in '
square feet or acres: I1H~.e.e W I u.., 'BE:. NO , O\p A ~:T '10 I..~.J AT~ f\ q LtAL, In..:
{='\6H Hf\t\rTl~1 f){t tS'LLttA..OLtNbtN<=( i\F.-SEJ\vOlt\ eNVI~DNI4A.€Nl

Applicant! Agent's Signature. Date
(Agent's signature is valid only if an authori ation letter from the applicant is provided.)

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Please approximately $~etc.h the 'foIowin,g int:armdlm on'DUplan
(please pnwldeclmenslQns for ead'llterns $ucb as 11 ft~ ,11;08 ft):
1) Alpmposed ngetation clearing (pro"';id, dimensions)
.2) Locali_ of . rap or fill to .be 'placed above the Full Pond elevation
3) Location of rip __p or rdl to be placed belaw the FulPond elevation
4) The location of .any pm,P-oNd sb"uctureslUChM bulldln.. Ntelnlng
walsr. doeb.etc, '
, 51 The location of any excavation or .edging be1owth& FUll iPond
elevation.
I) Localon of cQnstruclon ateess corrldQrs.

Triage Check List

Date: 1170/01.t Project Name: Cecd T - Lew')
DWQ#: o'-{ o-u rO
County: f{Ol.vaY1.
To: 0 ARO Mike Parker" D WaRQ Tom Steffens
D FRO Ken A veritte o WiRO Noelle Lutheran
~ MRO Alan Johnson o WSRO Daryl Lamb
0 RRO Steve Mitchell

From: ().. VI 1'1'1 .f jlVi /H'\

Telephone: (919) 7JJ - 77/'

The iIle attached is being forwarded to y~ur for your evaluation.
Please call if you need assi~tance. ,

" 0 Stream length impacted
o Stream determination
o Wetland determination and distance to blue-line surface waters on USFW topo maps
D Minimization/avoidance issues
o Buffer Rules (Neuse, Tar-P~co, Catawba, Randleman)
o Pond fill .
D Mitigation Ratios
D Ditching
o Are the stream and or wetland mitigation sites available arid viable?
D ' Check drawings for accuracy
D Is the application consistent with pre-application meetings?
D . Cumulative impact concern

Comments: J:"sth.R frvfo~..J e~CeivO\.+.'"" ('eM(}Y1...tf.? lA./;i( 'e~c(ivll.f"/~ JYA,'.... o.J[qc(nT

w-efl<lIl\.J~ ? t101,; wl~l{ -fh,-S 't (!.(.~tJ "o..di'l. e'enrJ. Lofs? If -fh,f .A.oN.l.'>1e !lfr<t;{ ?:a.f/,,'1.
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ALCOA~;

WE
.Alcoap,o\V~r Generatir;i,9 Inc, i.... TLANDS /401 GROUP
Yadkin Division . , Il
Post Office Box 576 ,,-,A 0 6 8 0 APR 2 7 2
Badin, North Carolina 28009-0576 004

Application forA~tivity Permit for Re~ervoir and Shoreline ~Af~~QbSECT10~
.. , ; . ,(Excav~tioi1,Dreclg"a,nd Fin) .', ' ,

Printortype aUinfonnationbelow and retumto APGI, Yadkill Divisioh,p:o. Box576, Highway 740, Ba~in, N.C. 28009'
, <', . '" .' . ,,'.. '.: (.. . . . ", .... . : . . . .' ;.'. ~ '- . ' , ' . ,

SECTION ONE-BACKGROUND INFORMATION (to be c9mpletedby the appli,cant)

t Full Name (adjoilling property owner): Ceoil T. and Sue C. Lewis, Jr.
2, P~a~entMailingAddr~: 4503 St. Andrews Drive,\Wilson,NC 2'7896

3, local Address (ifdifferent):
4. Telephone (Business): Nj A (Permanent): 252-234-9404 (local):

5. Fax No. and E-mail (optional):
6. Rese";oir. ...H~gb,' :Rock.. Lake ,. I Townst,'lip: Proyidenoe 8. County: RowaiJ.

9. SubdMsion:'10.Section: . One (1).
11. Lot No,: , 12. Tax Map No.: 606A 019

13." P~ecto. nst9'Dropertvrrfnfli' sary.,~eth~. ~~edd~' 'ng~h~.t tooprOVl.. 'deN artlat'~tthes~~):1187NGff:mS~~bUIid' right, on
~;,,":1lr~,,\."f'l a;6pro ma,'te Y m es 0, 'O'CllIlan L . eliC , otg~ it o..an ~...
:r \) apprbxlitld:t.e1yl m1. e to ~b e o1.n Su. on,le ',,0 1,/,rsl Lj. m1. e OIl e t.

14, Is the shoreline along the property described a!)qve design~ed as a "High Cultural Probability ZOne" in Yadkin's Shoreline Management Plan (leave blank if
you do not knoW):' · 0 YE!S 0 No \, ,. ' . ,', '

SECTION 1W~NFORMA nONFqR RESERVOIRANDSI:IOREUNE ALJERJ:\110N (attach the folloWing to :the application)

, ,
1. Map of the reservoirarea Vvtlere the excavation is proposed- applicant must attach amap of the area of the reservoir and adjoining shoreline property owned
by the applicant Vvtlere excavation is proposed. . The map must clearly exhib~ the area of the proposed excavation andto wh.~ depth (contour elevation) the
excavation is peSed, ' _ ., .'. .' . .', .. ., ., ,., ,

2. Description of the planned exeavation - applicant must attach awitten description of the planned excavationinclul;iingan estimate.ofthElfeservoirbottom to be
modified and the amount of material to be removed from the reservoir.

3. Plan for disposal of excavated material- app1icarrt must attach a Witten desc!iptiQn of their plans for disposing oftheeXcavatecj sediment No sediment may
be disposed of within the FERC project boundary(655 foot c:ontour),oron Property~ed or managed by Yadkin' or Alcoa.

4: Resource impads assessment - applicant must attach a briefWnttendescription.ofthe,potential impacts of the propOSedexcaVcmon activity on surrounding
reservoir resources, ipclu,ding impa.ctsto waterquality and fish habitat. If there isany vegetation growing in or around the area of proposed excavation, ~ ..
should be rioted and the a~eas of vegel:atjorl'Should be photographed, and photos included yWh application. '.'
::.-.'. ." . .; ," .., "', . ",,,...~,.;t: '., ,', ; ,

5, Schedule for conducting the propoSed excavation- applicant must attach a witten SchediJleforcompleling the propoSed excavation.

6. .A.gency Approvals'- applicant must attach copies of witten concurrence with the proposed excavation from the following agencies (refer to Instructions for
Applicelion for AciMty Permit for Reservoir and Shoreline ExcavEtion):

. U.S. Army Cotpsof Engineers
. North Carolina DMsion of Water Quality
. North Carolina Department of Cultural Resources (required in "High Cultural Probability Zones")

7. Non-refundable permitting fee - applicant must include a check or l11oneyorder made payable to APGI, Yadkin DMsion in the amount of$1 00.00
SECTION THREE (to be completed by the applicant)

, '.' , '-' "" ,',"
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I herebyapplyfor a pennit perf?Pnthe above-described shoreline aheration atHigh Rock Reservoir. I agreetoabide by all appliCable requirements of
Yadkin's Shoreline . ementJ>lan, the conditions oftheActivi{yPermit for ReselVOir and ShorelineAlteration (Excavation, Dredge, andFill) and other
y . ~ . ents. I also a~ that no wotk will begin until I receive anActivi{y PemU'tsignedby Yadkin.

2J.

nt'sSig~re ..~.. .....:). ,. . .~
'. ~
" {., .
White Copy - Yadkin

Date

l(-~- D.1j

Page 10f2

Canary Copy - Applicant

Pink Copy - Other

...

Instructions for Application for Activity Permit for Reservoir and sholiine Excavatio:
(Excavation, Dredge, and Fill) .

Instructions

To be considered for an AdMty Pennit for Reservoir or Shoreline Alteration (Excavation, Dredge, and Fill), the adjoining property owner (or a duly authorized
representative) must retum to Yadkin a fully completed application, letters of concurrence from the appropriate agencies if necessary, and a check made out to
APGI, Yadkin DMsion for the proper application fee. Please consult Yadkin's Shoreline Management Plan and Shoreline stewardship Policy for detailed
information regarding Yadkin's procedures and requirements governing activities in the reservoirs, along the shoreline, or in the Yadkin-managed buffer (this
information is available online atVMW.vadkininc.com).

Yadkin will sign and retum to you the Activity Pennit for Reservoir and Shoreline Alteration after Yadkin has reviewed the documents to ensure that the
proposed adMty will be in compliance with the Shoreline Management Plan, the Shoreline stewardship Policy, and all other applicable Yadkin policies,
procedures and requirements. You (the adjoining property owner) may not commence work until such time as you have received from Yadkin the Activity
Pennit for Reservoir and Shoreline Alteration, '

Requirements

1. Alteration of the existing reservoir bottom or shoreline, such as removal, addition, or fill (otherthan Yadkin-approved stabilization measures), or
modification of rocks, soil, sand, and sediment (induding dredging and excavation), is prohibited on NarrQlA/S, TuckertOM1, and Falls reservoirs.
2. On High Rock Reservoir, in recognition of the high rate of sedimentation that occurs, Yadkin may pennit excavation of reservoir sediments to maintain or
create recreational boat access to private piers: Excavation at High Rock Reservoir is by 'Mitten pennit only in accordance with the following standards.
3. All excavation must have prior 'Mitten approval from the U.S. Army Corps of Engineers and the North Carolina DMsion of Water Quality (NCDWQ). For
further information regarding these approvals, you should contact these agencies directly at the folletMng addresses:

Anny COrps of Engineers

Davidson County Montgomery Courty Rowan or stanly eourty
U.S. Army Corps of Engineers U.S. Army Corps of Engineers U.S. Corps of Engineers
Mr. John Thomas, Program Manager Mr. Allen S. Davis, Program Manager Mr. steve Chaplin, Program Manager
6508 Falls of the Neuse Road Post OIIice Box 1890 151 Patton Avenue, Room 143
Suite 120 Wilmington, N.C. 28402-1890 Asheville, N.C. 28801-5006
Raleigh, N.C. 27615

North Carolina Division of Water Qualily

Davidson County
Ms. Cindi Bell
4401 Reedy Creek Road
Raleigh, N.C. 27607

Rowan Courty
Mr. Todd st. John
4401 Reedy Creek Road
Raleigh, N.C. 27607

4, Excavation of the reservoir in areas adjacent to shoreline that has been designated as a "High Cultural Probability Zone" in Yadkin's Shoreline
Management Plan requires prior 'Mitten approval from the North Carolina Department of Cultural Resources (NCDCR). For further information regarding
this approval, you may contact the NCDCR at the folletMng address:

NC Department of Cultural Resources
OIIice of state Archaeology
Dr. Billy Oliver, Archaeologist
109 East Jones Street
Raleigh, NC 27601-2807

5, Only excavation in the dry is permitted and must be performed ...men the reservoir is drawn down sufficiently to access the excavation site. No dredging
(in the wet) is pennitted in conjunction with the construction or maintenance of private piers.
6. The excavation must not alter the reservoir shoreline at normal full-pool elevation (655 feet at High Rock Reservoir).
7. No excavation is allowed in areas of wetland vegetation.
8. Excavation may not occur during the months of March through June because of potential impacts to fish spawning.
9. The shape and depth of the excavation must be such that water will drain freely from the excavation ...men the reservoir level drops below the level ofthe
excavation.
10. All excavation must be placed landward of the normal full-pool elevation (655 feet at High Rock Reservoir).
11, IndMduals conducting the excavation are responsible for disposing excavated materials in compliance with North Carolina Department of Environment
and Natural Resources (NCDENR). For further information regarding the disposal of excavated materials, you may contact NCDENR at [phone].
12. Yadkin reserves the right to require priortesling of sediment in the area to be excavated and reserves the right to deny pennission for excavation based on
the test results.

Page 2 of2

White Copy - Yadkin

Canary Copy - Applicant

Pink Copy - Other

"';~pp:rica.tion for l1.cti vi ty ~:'ermi t for:~;eservoir 3....l1d 3horeline :n teration
,:a.ge 2

Jecil T. and Sue C. Jjewis
4503 St. AndreHs Ave.
Hilson, NC 27896

WETLANDs 1401 GROuP
APR 2 7 2004
WATeR QUALITY SECTION

Pebble Point dubdivision - Lot #19

Section Two - Information for Alteration

1. haps and photographs attached. The deptb of contour elevation will be
excavated to 8 feet.

2. Excavation ~dll be done using a front end loader. Approximately 90 cubic
yards of soil 1...111 be removed 1n an area 1200 square feet by 2 feet deep.
Digging will be done so water will drain out into main body of la1<;e.

3. Excavated material will l)e removed to a site not located wi thin the
boundaries of ~r.igh Rock Lake.

4. There will be no impact to water quality, fish habitat or surrounding
reservoir enviro~~ent. There is no vegetation growing in area to be
excavated - photos enclosed.

.5.illxcavation will be done in late fall (':Jovember or December) 200/-1- '\Irhen l^rater
level is at lowest point and lull be done in dry soil. Project should be
completed in less than one week. All excavation will be scheduled after
appropriate pe:rmi t is recel ved from Yadkin' s :3horeline l'ia,nagement Plan,
Alcoa Power Genera ng c.

Ap~ca.r t
;pl:

,

bI?~~~

. 1f-r--~i
Date

April 5, 2004

'1'0 ;~horTl. it i-lay Concern:

8;nclosed please find Application for Acitivity rermit for Heservoir and
Shoreline Excavation. If you have any further questions or need additional
information, please call me at 252-234-9404.

Thank you for your consideration and

assistance in this ma%2te. -

d~.. ~ ~
\,

'. <l.'. /1 Vy .
~L L-- ~~
qecil 'I't Lewis, Jr.
..)ue C. eWlS

WETLANDS 1401 GROUP
APR 1 2.2004
WATER QUALITY SECTION

L

of( W A r~1t
&" Oc..
o y
- r
> -
_ -l
o "

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources

Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality

April 20, 2004

CERTIFIED MAIL

FILE.' GUh

Cecil T. & Sue C. Lewis, Jr.
4503 St. Andrews Dr.
Wilson, NC 27896

I /.,
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Dear Mr. & Mrs. Lewis:

On 4/12/04, the Division of Water Quality received your application for the proposed Reservoir
and Shoreline Excavation in Rowan County, North Carolina. Please note that beginning January
1, 1999, the N.C. General Assembly passed legislation requiring payment of a fee for all 401
applications, as indicated on page two of the PCN application form. Your application is being
returned since no payment was received with the package. The fee for applications is $200 for
projects impacting less than an acre of wetland and less than 150 linear feet of streams. For
projects impacting one or more acres of wetland or 150 or more feet of streams, the fee is $475.
In order for DWQ to review and process your request, you must send a check in the appropriate
amount made payable to the N.C. Division of Water Quality attached to your application.

Please note that enclosed with this letter is a GP 30 Form Application for this type of work
explained above. Please fill out this form in its entirety and send back with appropriate
application fee. A complete submittal to our office must include a total of (7) collated copies
including site plans and vicinity maps.

If you have any questions regarding this letter please do not hesitate to call me at (919)-733-
1786. WETLANDS /401 GROUP

APR 2 7 2004

~S!n~~rely~
~~~
lVlichael Horan

WATER QUALITY SECTION

Enclosed: GP 30 Application

[phone]

Customer Service
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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 $200.00 for
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/Applicant Information d . A I 'T,
Name: t!.i: l'..1 L ~ ~ .;) ~. "-. /-' ~t(/ I}, :eLL.
Mailing Address: tl 1,.3- o~;--~JlI1~#8' "ft { ~/

Telephone Numbert?l507 - ~ 3'1 - Q'l01 Fax Number:
E-mail Address:

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:
c.ompany Affiliation:
Mailing Address:

Telephone Number:
E-mail Address:

Fax Number:

II. 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

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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:..:RnwAN Nearest Town: 0A~lS B ~
Subdivision name or site address (include phase/lot number~E ~ '- E... ~
Directions to site please include road numbers, landmarks, etc. (This is not 1/ H-AS E I
necessary if an adequate vicinity map is included): J..-DT -4:l1 q

J T)A'P r N Q..,L,.. ~~ b

2. Describe the existing land use or condition of the site at the time of this
application: Lltl12E=-~ L-OPED 11~ ~~ ~ I.C I L b I N~ f..,O"L -
} :>OT !~AS _R E~'2-!S ""It- Y--_ ~,--rAT1 DN -- ----=r:a~f:\ E Eli.~
('SO ,R,€,cS O~ 'leqF-rl1Tl O~ ON 1f1-~~A TO see
€-KCA yATtD -..5 f1N (f)q 9 D lL- I N A ~ E.~,
3. Property size (acres): to 4- If ~

4. Nearest body of water (stream/river/sound/ocean/lake):

.~

6. List the type of equipment to be used to construct the project:5 ~ 0 NT f: tJ D
LD 11;0 E' A "-\- -r-P\ lA.- e..-~ .
CvJ\ loLLA €f.,e, An 0";. LUtw.. t5t,. a'fl\ 'Ii ~Tte.!l
7. Amount of impact (including all excavation, backfill, rip rap, rJi?unp ~~ (;) - ~'.,
etc.) below the normal pool lake level in square feet or acres: ~ ~ I ds
OF-: . . 0 en f\ 00
.Q, r:=T, j)e~.D,qctINqWL~ ~~~e... 6DWATe:~. WIt.LiDIU\ltJ ,,\I,D
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap, M~"~lOD~
retaining walls, etc.) above the normal pool lake level and 50 feet land-ward in L
square feet or acres: ne.iE. W lu... 'BE NO I nvp Ae..-T 10 WAT~ f\.. qUAL 1/11
f='\6l:-t l-H\flrTln t')ft l<;'LL~A.OLLtJbrNq "'€>SfJ\vOlr\ eNVI~DNw..EN1

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Applicant! Agent's Signature Date
(Agent's signature is valid only if an authori ation letter from the applicant is provided.)

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Please ;approxindely _etch the fGlDwingnarmaticm on ..... plan
11*_ provldedlmenaionsfor eadI brn~ such Q 18.1..:11....1):
1) AI proposed __aUon clearing (pn:wld, dlmensiona)
.2) LocatiDn of rip rap or fill to be placed abHe the Full Pond elevation
3) Location DI rip ... or flll to be! placed below the FulPond. elevaUon
4) The Iocatlon.of any propDsed sIructures such as bulldlnga. retaining
~ docks.ltc.
5) The location of any exeavation or dr8dging below the FUll Pond
elevation.
I) Localion of coMtructlon access CDITIdOrs.

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