20042009 Ver 2_401 Application_20110223

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The following is an abbreviated application form for those applying fora 401 W'ater Quality
Certification to impact FERC (Federal Energy Regulatory Commission) regulated lake shore or
bottom under the U.S. Army Corps of Engineers Permit CP30. This Application cannot be used
for wetland or stream impacts. Please provide fire (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 I acre and $570.00 for impacts to lake bottom of greater or
equal to l acre.
Applications should be sent to:
Division of Water Quality 401 (hcr:5igh1/P.•xpress Review Permitting
1650 Mail Service Center
Raleigh, NC 27699-1651)
I. Applicant Information
1. Owner/Applicant Information
Name: Dz#Jr'J is
Cl
Mailing Address: Lr'?A 1V7
Telephone Number: 3 3 ii, Fax Number:
E-mail Address: _
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address: _ r--?
Telephone Number: ° --
E-mail Address: r_......_.
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II. Project Information DEB 2 3 2011 F E 1)
2011
W & vvA>Ep Al. DENR - tNATEF2 Q
Attach a vicinity map clearly showing the location o espect to t
as towns, rivers, and roads. Also provide a detailed site plan showing property boundaries and
development plans in relation to surrounding properties. You may use the diagram below to make a
hand sketch of your project. Also, see the example below for guidance. Both the vicinity map and site
plan must include a scale and north arrow. The footprints of all buildings, impervious surfaces, or other
facilities must be included.
l
I. Location
County: W Nearest Town: 1C)--_
Subdivision name or site address (include phase/lot number): 221n! ?1`$ ?.
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included):
Tr Aii
3. Property sire (acres):
4. Nearest body of water (stream/river/sound/ocean/lake): Kt;c-h ?? j e?y1 c4-
5. Describe the purpose of the proposed work: jr. (al'
s? hr e, lt? IL.
6. List the type of equipment to be used to construct the project: _.P .ak V crte,y
7. Amount of impact (including all excavation, back ill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: I" e 7-$1 o"h-, ,,,, A
8.a. Amount of imliact (including alf 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: O'A
}
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): AJ,A
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
2. Describe the existing land use or condition of the site at the time of this application:
© Alcoa Power Generating Inc.
Yadkin Division
ALCOA Post Office Box 576
Badin, North Carolina 28009-0576
Application for Activity Permit for Reservoir and Shoreline Alteration
(Excavation, Dredge, and Fill)
Print or type all information below and return to APGI, Yadkin Division, P.O. Box 576, Highway 740, Badin, N.C. 28009
SECTION ONE - BACKGROUND INFORMATION (to be completed by the applicant)
1. Full Name (adjoining property owner): G <
2. Permanent Mailing Address:
3. Local Address (if different): 4. Telephone (Business): (Permanent): 7' n '4 - (Local) f T
5. Fax No. and E-mail (optional):
6. Reservoir. e -` N C11r Dr 7. 8. Cou
Tawmship (1, a $ ctY
9. Subdivision: 10. Section:
11. Lot No. 12. Tax Map No.:
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13. Directionst to property (ff necessary, use the,,closed drawing sheet to provide us a map to the site)
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14. Is the shoreline along the property described above designated as a "High Cultural Probability Zone" in Yadkin's Shoreline Management Plan (leave blank if
you do not know): ? Yes ? No
SECTION TWO---INFORMATION FOR RESERVOIR AND SHORELINE ALTERATION (attach the following to the application)
1. Map of the reservoir area where the excavation is proposed - applicant must attach a map of the area of the reservoir and adjoining shoreline property owned
by the applicant where excavation is proposed. The map must dearly exhibit the area of the proposed excavation and to what depth (contour elevation) the
excavation is proposed.
2. Description of the planned excavation - applicant must attach a wrdten description of the planned excavation including an estimate of the reservoir bottom to be
modified and the amount of material to be removed from the reservoir.
3. Plan for disposal of excavated material - applicant must attach a written description of their plans for disposing of the excavated sediment No sediment may
be disposed of within the FERC project boundary (655 foot contour), or on property owned or managed by Yadkin or Alcoa.
4. Resource impacts assessment - applicant must attach a brief written description of the potential impacts of the proposed excavation activity on surrounding
reservoir resources, including impacts to water quality and fish habitat If there is any vegetation growing in or arourilithe area of proposed excavation, it
should be noted and the areas of vegetation should be photographed, and photos included with application.
5. Schedule for conducting the proposed excavation - applicant must attach a written schedule for completing the proposed excavation.
6. Agency Approvals - applicant must attach copies of written concurrence with the proposed excavation from the following agencies (refer to Instructions for
Application for Activity Permit for Reservoir and Shoreline Excavation):
• U.S. Army Corps of Engineers
• North Carolina Division of Water Quality
• North Carolina Department of Cultural Resources (required in "High Cultural Probability Zones")
7. Non4efundable permitting fee - applicant must include a check or money order made payable to APGI, Yadkin Division in the amount of $100.00
SECTION THREE (to be completed by the applicant)
I hereby apply for a penuit to perform the above-described shoreline alteration at High Rock Reservoir. I agree to abide by all applicable requirements of
Yadkin's Shoreline Management Plan the conditions of the Activity PernritjorReservoir and Shoreline A Iteration (Excavati on, Dre dge, and Fill) and other
Yadkin procedures and requirements. I also agree that no work will begin until I receive anActivity Permit signed by Yadkin.
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Applicant's Signature Date
Page ] of 2
White Copy -Yadkin Canary Copy -Applicant Pink Copy - Other
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