20110617 Ver 1_Application_20110701

2 0 1 1 0 6 1 T
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 $240.00 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

1. Applicant Information
1. Owner/Applicant Information
Name: 1?0 Aw'"5 I A 4fww? fl V E PPOPGALI ES
Mailing Address: 106 C6wAA '*F_ `I" 1z*6-
1. )(ttab ot,S . NC X119'2-
Telephone Number: 'ViGtelt5fF MiL& 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: it 1 h
Company Affiliation: ?
Mailing Address: ,
Telephone Number: Fax Number: NR ?0
E-mail Address: q
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.
1. Location
County: bbl i u, 5rr-j Nearest Town: LE)Q P 4'ToA
Subdivision name or site address (include phase/lot number): WT -5 T&Vey-V'i EW "5
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included): i ° 6 fo i204izit") EV '
/V
7
2. Describe the existing land use or condition of the site at the time of this
application: EX15 T,06 ffivsc OP PaOrEpa f
3. Property size (acres): At'AImy, 0, to A-c-i27E3
4. Nearest body of water (streamhiver/sound/ocean/lake): i&R- acce- LAVE
5. Describe the purpose of the proposed work:
To `),TABiL4 1: E 'TRE ElZ6 4CD 5HpRZW0r
6. List the type of equipment to be used to construct the project:
Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres:
8. a. Amount of impact (including all
retaining walls, etc.) above the normal
square feet or acres: 7.
clearing, back fill, excavation, rip rap,
pool lake level and 50 feet land-ward in
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): No VEGETATIOl UJfLL F3e
App 'canMkgent s rgnature Date
(Agent's signature is valid 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
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
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
US Army Corps Of Engineers Alamance
Alleghany Durham
Edgecombe Johnston
Lee Rockingham
Stokes
Lj

euse ad
6SD8'Fa1J
uit 0
ft'

Ashe
Caswell

Franklin
Forsyth

Nash
Northampton

Sung
Vance
(IE5)
FiV J e? h, C 2} 15
Telephone: [phone]
7 Granville
Guilford Orange
Person Wake
Warren
Fax: [phone] Dav Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Hamett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [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 Tro ut 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
D -1 CAT, 0
-.?i?P Ll ?Tt o?1 ? (L SF}? R.??.? N L ?1?? ? i I. I Z.,?A7? o (?_.? _?_?._._.._ __
'5o U1 5 / hokwL5 fiJE
LoT.34
_._L1V -1z Jt tA.l ?? ?E5

? i-r?c.Fl Gtr ?No2?U N E P(,?N ?v F?u?s ? a
SNZ(Z-6VINI? ?T-ANII iZA;TiOM
GTA &05 SRS f'rz??'Q ?-t? ?lka2C-t.?N ?t,oPE
?__ _ T t S a2' ?__I D At,5t) 'Wio5 TN E D tr4' i VT ±f No_04TAd
4 _ Rt I V N T AR \/C-
..T M ,.Ntm Ate( ,F6-0 C,
A AEA o'F- (i?PACT-_-_= L NGTIN?-?-Dtffi? ` StOPC_
5 x.? x 2.?
_
4

?N S g A?sum ED 741 5 iU lVu
R__. _

CPA-VAS Coj(
t w? P ITT / ? v N 1?-- P tra - __ ____ (t L-'?v? Set
--

LIN
?' Irk . ? i ,
_ l_ h ' T CAN ?T (Z u CTO cNO _- bTkL
5

aVidson County Map Output Page
Davidson County
GIS

E34 \ E33
E27
<s /
Page 1 of 2
7ZE28 °
suiS,? aCT
Phf?tEl-
56
E32
64?
RIVERVIEW
PUBLIC
Scale: 1 in. = 42 ft.
Parcel Number : 06030DOOE0032 Land Units: 1 LT
Pin Id : 6710-03-13-5896 Deed Book: 1870 Pb: 1559
ADAMS FIVE
PROPERTIES LLC
Owner : 106 COMANCHE TRAIL Deed Date: 06/18/2008
LEXINGTON NC
272950000
3/30/2011
'04
-0
Lg7)
'Put '01V
I
CN
RIP FLAP

. r i
VEGETATION AND EROSION
/ CONTROL FABRIC
T\
EXISTI NG GRADE

3 C7

I
CLASS 2 RIP RAP I

2 I
f'
EROSION CONTROL FABRIC

LAKE BOTTOM - -
TYPICAL CONDITIONS
36" TO 72" ERODED CUT
WAVE EXPOSURE
04/19/11
FOR: ADAMS FIVE PROPERTIES, LLC
LOCATION: LOT 32, RIVERVIEW ACRES
RESERVOIR: HIGH ROCK LAKE
PROJECT: SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. - BADIN, NORTH CAROLINA
DRAWING TITLE: DETAIL
MODERATE RIP RAP STABILIZATION 3

TS5 -b ?

V y ? ? l.' ?,?faR.,
r ? 4
r'e
t --
??

SIRO1tEI.INE MANAGEMENT PLAN
CJY,

ROCK