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Telephone Number: 04
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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 $20.00 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 15 ftl D

1. Applicant Information
1. Owner/Applicant Information
Name: VC
Mailing Address: qi
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: P /A
Company 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
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.
Location
County: ft4-u4I &Co&E I?LI Nearest Town: F- tCi4fICLD
Subdivision name or site address (include phase/lot number): l cT-13 i AJIU N6 roN f;&Zg2Y
Directions to site please include road numbers, landmarks, etc.- (This is not aWRAimig PGt??
necessary if an adequate vicinity map is included):
PSG RWI Ala -16 BAP-114 iA, PcAD (5F, tyL Sbaill TO U-4 NQIZIH
'PRcsl'ER`T'i
2. Describe the existing land use or condition of the site at the time of this
application: {+eanl: LLPDEIZ C is S g"ateN
E)Lt,5TW O RESIDCN'T1A-L- Srt GDJVI$it3/),
3. Property size (acres): 0.5'z ACC,2E 5
4. Nearest body of water (stream/river/sound/ocean/lake): UWJ L_A*;F
5. Describe the purpose of the proposed work: Tic 5'TA BI t.Ut; W ;5(151_ IJG EIkDED
MD PR41Ct.7t- I-" Ffzcwt _f!kP_i ffto EiZC?SiO14.
6. List the type of equipment to be used to construct the p
1O3CA , SVVI AU, ' T tZA<;Tv V_ C)t2 PA
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres:
2,44 so. F7-,
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: 10399 K- ET,
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): 5o- 37 IKEt 5 OF VA-121967 At E
Avo CoOjDt wf,; Wit,L 13C F-etyzuED To a VKpl e,rE -TttC 5T/A3iLiIXT"tc/'N 7
/1
kpplicant&nt's Siatu`rr' Dane '
Agent's s a re is alid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell Union
US Army Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Berrie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret" Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans "Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Richmond
Wilmington, NC 28402-1890 Carteret ontgomery Robeson
Telephone: [phone] Columbus Sampson
Fax: [phone] Cumberland New Hanover Scotland
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
North Carolina State Agencies
Division of Water Quality Division of Water Quality State Historic Preservation Office
401 Wetlands Unit Wetlands Restoration Program Department Of Cultural Resources
1650 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
Raleigh, NC 27699-1650 Raleigh, NC 27699-1619 Raleigh, NC 27 699-46 1 7
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Berrie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kemersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
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• Montgomery Co,, NC -- Printable Map
Montaomerv County, NC
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DISCLAIMER: The information contained on this page is NOT to be construed or used as a "legal description iviap inrorrna
believed to be accurate but accuracy is not guaranteed.
Parcels
Parcel No: 6673 18 32 3256 Lot Number: LOT 23 (WATERFRONT) Building Value: $0
Parcel Address: 520 PENNINGTON Legal Description: PENNINGTON Land Value: $297,791
FERRY FERRY Other Value: $0
Parcel Owner: Deed Reference: Bk. 620 Pg. 292 Total Tax Value: $297,800
IRWIN, KELLY C. & DENISE L. Land Area: acres Sale Year: 08
4138 MOURNING DOVE DRIVE Year Built: Sale Price: $390,000
WEDDINGTON, NC 28104
6/22/2010

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VEGETATE DISTURBED AREA
ABOVE SLOPE
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EROSION CONTROL FABRIC
TYPICAL CONDITIONS
12" TO 36" ERODED CUT
WAVE EXPOSURE
LAKE\
BOTTOM
08/19/10
FOR: KELLY IRWIN
LOCATION: LOT 23, PENNINGTON FERRY, UWHARRIE POINT
RESERVOIR: BAD I N LAKE
PROJECT: SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. - BADIN, NORTH CAROLINA
EXISTING GRADE
DRAWING TITLE: DETAIL
MINOR RIP RAP STABILIZATION 2

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ARROWS DAM
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Morrow Mtn. State Part

SHORELINE MANAGEMENT PLAN
FALLS DAM