20130057 Ver 1_Application_20130123

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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 $570.00 for impacts to lake bottom of greater
or equal to 1 acre.
Applications should be sent to:
Division of Water Quality 401 OversightlExpress Review Permitting
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information j
1. Owner /Applicant Information 1
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Name: /•� t d W
Mailing Address: 3 g % A 1"46. %: u .
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Telephone Number: 00018' Ag 3 A 0.3 Fax Number: g,P f 't L -,9'3 % /
E -mail Address: 'j�o S /3Y b% ., Q 4 1 k. (f o y"
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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: Fax Number.
E -mail Address: h� � 0 .� � -� v
H. 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.

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1. Location
County: Nearest Town: Nd rtl (ii�-.4j
Subdivision name or site address (include phase/lot number): Ae-AIZ£ Ae RCS
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): ih 'P &S- f14 s o
41-
vicinity fYb WWI
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2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): -' Aemur,
4. Nearest body of water (stream/river /sound/ocean/lake): K rr. t r
5. Describe the purpose of the proposed work: Fo, tk i Pro- rr e,S . N fl t
l: s
6. List the type of equipment to be used to construct the project: � lr t E '2
7. 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 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:
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): �a _-,- I0SY
/ - / �1- /3
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
W. KERR SCOTT DAM & RESERVOIR
499 RESERVOIR ROAD, WILKESBORO, NC 28697 -2330
PHONE: [phone] FAX: [phone]
Visitor Assistance Center
Bob Brown
381 Hardin Road
Boone, NC 28607
Dear Mr. Brown:
September 28, 2012
This letter is in reference to your erosion control request. Please follow the instructions
below:
1. Obtain a permit from NC Department of Natural Resources that will allow you to conduct
grading at normal water level. No projects are planned by the Corps of Engineers at this
time that will lower the water level. Provide our office with a copy of the permit.
2. Once the NC Department of Natural Resources permit is obtained, we will need to set up
a meeting with you and the contactor Dixie Grading at the field site.
3. We tentatively approved the proposed plan by Dixie Grading dated May 4, 2012. Final
approval will be given once the NC Department of Natural Resources permit is obtained
and a meeting with you and the contactor has been conducted.
We appreciate the time, effort, and cost you are enduring to protect the shoreline of W.
Kerr Scott Dam. This will be a highly visible project to the public and we will insure all
measures are taXen to protect the water quality and aesthetic value of the land.
If you have any questions concerning this letter, please contact the Shoreline Ranger at
336 - 921 -3390.
Sincerely,
. —9v�— —�
Kevin Heape
Operations Manager

" SCHEDULE' A"
LEIS FORK TOWNSHIP WILKES COUNTY NORTH CAROLINA
BEGINNING at a west corner of Lot No. 4 in the East margin of Pine Drive (said beginning
being designated on map as Control Corner No. C 12 Wilkes County DTD- November 25, 196 1)
and running thence South 15 degrees 12 minutes East 110.34 feet to a stake; thence. South 15
degrees 15 minutes East 140.52 feet and then approximately 250 feet further on same course to
the US Government tract; and then South 77 degrees 28 minutes East approximately 100 feet to
Point 2 shown on map; thence with the US Government line, North 28 degrees 30 minutes East
115.71 feet to Point 3 shown on map; thence North 12 degrees 20 minutes East 301.84 feet to a
point; thence North 60 degrees 55 minutes West 141 feet to the north corner of Lot No. 4 on Pine
Drive; thence with the East margin of Pine Drive, South 29 degrees 05 minutes West 75 feet to
the beginning.
The above described property being all of Lot No. 4 as shown on map of Ackle Acres map of
which is recorded in Plat Book 5, Page 41 of the Wilkes County Registry. Also included in this
Deed is property herein described by mete and bounds and lying between the extension in an
eastward direction of ht enorth line of Lot No. 4 and an extension in S- eastward direction of the
west line of Lot No. 4 and government property on the south and the east as shown on said map.

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