20120860 Ver 1_Shoreline Stabilization_20120917

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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 $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
I. Applicant Information
1. Owner /Applicant Information
Name: �e
Mailing Address:
Lt:�c�NGToN . NC 7-1 29 Z
Telephone Number: ' 0 - Z0 Zg 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: kx /.
Company Affiliation: /
Mailing Address: a
Telephone Number: Fax Number:
E -mail Address:
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: bA4I D 5014 Nearest Town: VY- Nfx i vN
Subdivision name or site address (include phase/lot number): i202 &VEE YEW J 2AO
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included):
S -$5 To NG Atdi v> . Sowxt1 To 5burft Moralr. R644T old UNWmv- SouTAmoatT
2. Describe the existing land use or condition of the site at the time of this
application: a 1ST i l 6 Nay S_ no wmk- p-ES! yearim, w'r
3. Property size (acres): O•ZS ku;_.ES -+I-
4. Nearest body of water (stream/river /sound/ocean/lake): VdGN PXY-
5. Describe the purpose of the proposed work: "t"a 5TM511.1-ft M LXt5 -006
ivooEO 5tke(ieuN'e
6. List the type of equipment to be used to construct the
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres:
IS o 5F
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: TIC) 5F
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): No EA% STINfa YQELk --VIoN
���70
91&44 _. Date
is valid only if an authorization letter from the applicant is provided.)

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US Army Corps Of Engineers Field OHlces and County Coverage
Regulatory Field Office
Alexander Cherokee
Iredell
Mitchell Union
(Ashe4le
y Corps of Engineers
Avery Clay
Jackson
Polk Watauga
on Avenue
Buncombe Cleveland
Lincoln
Rowan Yancey
08
Burke Gaston
Macon
Rutherford
e, NC 28801 -5006
Cabarrus Graham
Madison
Stanley
ne:(928)271 -4854
Caldwell Haywood
McDowell
Swain
8) 2714858
Catawba Hendmson
Mecklenburg
Transylvania
Raleigh Regulatory Field Office
Alemance Durham
Johnston
Rockingham Wilson
US Army Corps Of Engineers
Alleghany Edgecembe
Lee
Stokes Yadkin
Ashe Franklin
Nash
Su"
-6sile-iag
Caswell Forsyth
Northampton
Vance
Raleigh, NC 241615-
Granville
Orange
Wake
Telephone: [phone]
avidson Guilford
Person
Warren
Fax: [phone]
Halifax
Randolph
Wilkes
Washington Regulatory Field Office
Beaufort Currituck
Jones
Pitt
US Army Corps Of Engineers
Bertie Dare
Lenoir
Tyrrell
Post Office Box 1000
Camden Gates
Martin
Washington
Washington, NC 27889 -1000
Carteret' Green
Pamlico
Wayne
Telephone: [phone]
Chowen Hertford
Pasquotank
Fax: [phone]
Craven Hyde
Perquimans
'Cmatan National Forest Only
Wilmington Regulatory Field Office
Anson Duplin
Ondow
US Army Corps Of Engineers
Bladen Hemett
Pender
Post Office Box 1890
Brunswick swick Hoke
Richmond
Wilmington, NC 28402 -1890
Carteret Montgomery Robeson
Telephone: [phone]
Columbus Moore
Sampson
Fax. [phone]
Cumberland Now Harwver 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 Sum
Pivots Island
Raleigh, NC 27636.3726
Asheville, NC 28801
Beaufort, NC 28516
Telophone: (919) 8564520
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 27699-4617
Telephone: [phone]
Telephone: [phone]
Telephone: [phone]
Fax: [phone]
Fax: [phone]
Fax-. (919) 715 -2671
CAMA and NC Coastal Counties
Division of Coastal Management
Beaufort
Chowan
Hartford Pasquotank
1638 Mail Service Center
Bertie
Craven
Hyde Pender
Raleigh, NC 27699 -1638
Brunswick
Currituck
New Hanover Perquimam
Telephone: [phone]
Camden
Dam
Onslow Tyrrell
Fax: [phone]
Carteret
Gates
Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator
Alleghany
Caldwell
Watauga
3855 ldlewild Road
Ash@
Mitchell
Wilkes
Kemeraville, NC 27284-9180
Avery
Stokes
Telephone: [phone]
Burke
Sum
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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Davidson County Map Output Page
Davidson County GIS
Scale- I In.. 36 R.
Parcel Number :
0603000ODDOOI
Land Units:
0.000 LT
Pin Id :
6710 -01 -36 -2916
Deed Book:
1808 Pg: 819
HARTMAN JERRY F
Owner:
P 0 BOX 955
Deed Date:
08/10/2007
DENTON NC 27239 -0000
Property Address:
1202 RIVERVIEW RD
Account Number:
9029857
Township;
Cotton Grove
Exempt Code:
Building Value;
$23,150 Other Building Value:
$11,100
Land Value:
$106,250 Market Value:
$140,500
Page 1 of 2
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CLASS 2 RIP RAP
EROSION CONTROL FA
VEGETATION AND EROSION
CONTROL FABRIC
EXISTING GRADE
LAKE BOOM
TYPICAL CONDITIONS
• 36" TO 72" ERODED CUT
• WAVE EXPOSURE
FOR` JERRY HARTMAN
LOCATION: 1202 RIVERVIEW ROAD
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

N Carolina 8 S to 1202 Riverview Rd, Lexington, NC 27292 - Google Maps
Directions to 1202 Riverview Rd, Lexington, NC
Gooqle 27292
8.5 mi — about 15 mins
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