20071200 Ver 1_Application_20070710

07-1200
APPLICATION FOR DEPARTMENT OF fiHE ARMY PERMIT ~ OMS APPROVAL NO. 0710-000
(33 CFR 3251 Expires f?ecember 31, 2004
The Public burden for this copectbn of ht€ortnation is sestimated to average 10 hours per response, ahhough the majority of applications should rep
5 hours or less. This includes the time for reviewing instructions, searching exisiEng data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any ath+er aspect of this coitectian of
information, rcicluding suggestrorts for reducing thle burden, to Department of Defense, Washington Headquarters Service Directorate of Informatior
Operatiarts and Reports, 3215 Jefferson Davis Highway, Suite 1204, Arl~gton, VA 2220?-4302; and to the ONIce of Management and Budget,
Paperwotlt Reduction Project 10710.0003}, Washington, DC 2050. Respondents should be aware that notwithstanding any other provision of ia~
ro person stsaH be subject to any perwlty for failing to comply with a collactian of fnformation if it does net display a currently valid OMB control
number. Please DO NOT RETURN your form to either of tf-ose addresses. Completed applications must be submitted to the District Engineer Navin
jurisdiction over tfse bcation of the proposed activity.
PRIVACY ACT STATEMENT
Autftorities: Rivers and Harbors Act, Section 40, 33 USC 403; Clean taster Act, Section 404, 33 USC 1344; Marine Protection , Research and
Sanctuaries Act,~33 USC 1413, Section 403. Principal Purpose: information provided on this form w711 be uxd 'pt evaluating the appEication for a
permit. Routine Uses: 'Chia information may be shared with the Department of Justice and other federal, state, and loco{ government agencies.
Subnvssion of requested information is voluntary, however, if information is not provided the permit application cannot be evakrated nor can a peer
be essued.
Ona set o! original drawings or good reproducible copies which show the locarion and character of the proposed activity must be attached ro this
application free sample drawings and Errstructiorts) and be submitted to the District Engineer having jurisdiction aver the bcation of the proposed
activity_ An applicatiwn thal is not completed in furl will be retutned_
1. APPLICATION NO. ~ 2. FIELD OFFICE CODE ~ 3. DATE RECEIVED ~ 4. DATE APPLECA710N COMPIE
%l7'EMS BFLDIN TO BE FILLED BY APPLIC,@NTt
5. AP'PLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TETLt .sr• np•-,-rr rs.:er ~~•rini;
Donald Wayne Miles Jr. Wayne Miles
t;. APPLICANT'S ADDRESS 9. AGENT'S ADDRESS
10806 US Hwy 21 South Same
PO Boa 299
Roring Gap NC 28668
?. A CANT'S PfiONE NOS. W~'AREA CODE 10. AGENT'S PHONE NOS. WJAREA CODE
a. Residence [phone] a. Residence Same
b. Business [phone] I
F b. Bu;;nes3 Same
t
1. STATEMENT OF AUTHORIZATION
I hereby authorize, to act in my behalf as my agent in the processing of this application anc
:urnish, upon request, supplemental information in support of this permit application.
APPLICANT"S SIGNATURE DATE
NAME, LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TETI_E rscr. ir~strwzxx~s
Chem Lane
13. NAME OF VJATER$ODY, lF ICN04NN ~uafrJ~L:4•~ ~ 14. PROJECT STREET ADDRESS .~~rd~,r.-r
Woodruff Road
15. LOCATION OF PROJECT
Alleahany NC
COUNTY STATE
!6. pTHER LOCATION DESCR41'TiONS. IF KNOWN, ~sr.R i2sr.u:wnst
17. DIRECTIONS TO THE SITE
Take US Hwy 2l North to state road number 1106 (Chem Lane
Rd). turn left and go 1 ~'2 mile, turn left onto Woodruff Road. Dam
sight will be on right in the first stream.

18. Nature of Activity tGesniFK%~Q`aa^~.~~=~eltrrwr:,res~
3 1 /2 acre lake, water 20 feet deep at dam
requiring approximately 900 feet of stream bed.
*See attachment*
13. Project Purpose !llrscribe ripe rc~sa+ w purpose or the projecr, see ir~.struciinns:
Land Development, Recreation.
USE BLOCKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
21. Typeis) of Material Being Discharged and the Amount of Each Type in Cubic Yards
22. Surface Area in Acres of Wetland, or Other Waters Filled ~see;nurucuiur<
23, Is Any Portion of the Work Already Complete? Yes No ~_ IF YES, DESCRIBE THE COMPLETED WORK
24. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (If more than can be entered here.
please attach a supplemental fist).
25. List of Other Certifications or ApprovalslDenials Received from other Federal, State or Local Agencies for Work Described in This Application.
AGENCY TYPE APPROVAL' IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
`Would include but is not restricted to zoning, building and flood plain permits
26. Application is hereby made for a permit or permits to authorize the work described in this application. I certify that the information in this
appiica' is co plete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the
duly th ized Bent of the applican
Z~~
RE OF APPLICANT DATE SIGNATURE OF AGENT DATE
e a tion must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed.
78 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false. fictitious ar
fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or
fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.

instructions for Preparing a
Department of the Army Permit Application
Blocks 1 through 4. To be completed by Corps of Engineers.
Bloct 5. Applicant's Name. Enter the name of the responsible party or parties. If the responsible party is an agency,
company, corporation or other organization, indicate the responsible officer and title. If more than one party is
associated with the application, please attach a sheet with the necessary information marked Block 5.
Block 6. Address of Applicant. Please provide the full address of the party or parties responsible for the application.
ff more space is needed, attach an extra sheet of paper marked Block 6.
Block 7. Applicant Telephone Numberis}. Please provide the number where you can usually be reached during normal
business hours.
Blocks 8 through 11. To be completed if you choose to have an agent.
Block 8. Authorized Agent's Name and Trtle. Indicate name of individual or agency, designated by you, to represent
you in this process. An agent can be an attorney, builder, contractor, engineer or any other person or organization.
Mote: M agent is not required.
Blocks 9 and 10. Agent's Address and Telephone Number. Please provide the complete mailing address of the agent,
along with the telephone number where he/she can be reached during normal business hours.
Block 11. Statement of Authorization. To be completed by applicant if an agent is to be employed.
Block 12. Proposed Project Name or Trt~. Please provide name identifying the proposed project (i.e., Landmark
Plaza, Burned Fulls Subdivision or Edsall Commercial Center).
Blodr 13. Name of Waterbody. Please provide the name of any stream, lake, marsh or other waterway to be directly
impacted by the activity. If it is a minor (no name) stream, identify the waterbody the minor stream enters.
Bock 14. Proposed Project Street Address. If the proposed project is located at a site having a street address (not a
box number}. please enter here.
Bloch 15. Location of Proposed Project. Enter the county and state where the proposed project is_ located. If more
space is required, please attach a sheet with the necessary information marked Block 15.
Block 16. Other Location Descriptions. If available, provide the Section, Township and Range of the site and/or the
latitude and longitude. You may also provide description of the proposed project location, such as lot numbers, tract
numbers or you may choose to locate the proposed project site from a known point (such as the right descending
bank of Smith Creek, one mile down from the Highway 14 bridge). If a large river or stream, include the river mile of
the proposed project site if known.
Block 17. Directions to the Site. Provide directions to the site from a known location or landmark. Include highway
and street numbers as well as names. Also provide distances from known locations and any other information that
would assist in locating the site.
Bbck 18. Nature of Activity. ascribe the overall activity or project. Give appropriate dimensions of structures such
as wingwalls, dikes (identify the materials to be used in construction, as well as the methods by which the work is to
be done), or excavations (length, width, and height). Indicate whether discharge of dredged or fill material is involved.
Also, identify any structure to be constructed on a fill, piles or float supported platforms.
The written descriptions and illustrations are an important part of the application. Please describe, in detail, what you
wish to do. If more space is needed, attach an extra sheet of paper marked Block 18.

Brock 19. Proposed Project Purpose. Dest;r(be the purpose and Head for the proposed project What will it be used for
and why? Also include a brief description of any related activities to be devebped as the result of the proposed project.
Give the approximate dates you plan to bath begin and complete all work
Bksck 20. Reason(s) far D"tscharge. If the activity involves the discharge of dredged and/or fill material into a wetland or
other waterbody, including the temporary placement of material, explain the specific purpose of the placement of the
material (such as erosion corrtro~.
Block 21. Type(s) of Material Being Discharged and the Amouet of Each Type in Cublc Yards. Describe the
material to be discharged and amount of each material to be discharged whin Corps jurisdiction. Please be sure this
description will agree with your illustrations. Discharge material includes: rode, sand, clay, concrete, etc.
Block 22. Surface Areas of Wetlands or Other Wags Filled. Describe the area to be filled at each location.
Specifically identify the surface areas, ar part thereof, to be fil{ed. Also include the means by which the discharge is to be
done (backhoe, dragline, etc.). If dredged material is to be discharged on an upland site, identify the site and the steps to
be taken (if necessary) to prevent runoff from the dredged material back into a waterbody. If more space is needed, attach
an extra sheet of paper marked Bk,ck 22.
Block 23. Is Any Portion of the Work Already Complete? Provide any background on any part of the proposed project
already completed. Describe the area already developed, strictures completed, any dredged or fill material already
discharged, the type of material, volume in cubic yards, acres filed, if a wetland or other waterbody (in acres or square
feat}. if ii-e work was done under an exisiing %orps permit, ider-ii"ry the author¢atiorr if possfDle.
Block 24. Names and Addresses of Adjoining Property Owners, lessees, etc., Whose Property Ad joins the
rraject Site. i_ist cornpiete names and full mailing aadresses of the adjacent property owners (public and private] lessees,
etc., whose property adpins the watetbody or aquatic site where the work is being proposed so that they may be notified of
the proposed activity (usually by pk-niic notice). If more space is needed, attach an extra sheet of paper marked Block 24.
Information regarding adjacent landowners is usually available through the atfice of the tax assessor in the
county of counties where the' project is to be developed.
Black 25. Information about Approvals or Denials by Other Agencies. You may need the approval of other Federal,
slate or local agencies for your project. identify any applicatiarrs you have submriteaf and me stsius, if any (approved or
denied) of each applicat'ron. You need not have obtained all other permits before applying for a Corps permit.
Block 26. Signature of Appl"rcant or Agent. The appC~cation must be signed by the owner or other authorized party
(agent) .This signature shalt be an affirmation that the party applying for the permit possesses the requisite property rights
to undertake the activity applied for (including compliance with special conditions, mitigation, etc.).
DRAWINC?S AND ILLUSTRA77dNS
General Information.
Three types of illustrations are needed to properly depict the work to be undertaken. These illustrations or drawings
are identified as a Vicinity Map, a Plan View or a Typical Cross-Section Map. Identify each illustration with a figure
or attachment number.
Please submit one original, or good quality copy, of all drawings on 8 1!2x11 inch plain white paper (tracing paper ar
film may be substituted). Use the fewest number of sheets necessary for your drawings or iqustrations.
Each illustration should identify the project, the applicant, and the type of illustration (vicinity map, plan view or
cross-section) . While illustrations need not tie professional (many small, private project illustrations are prepared by
hand), they should be clear, accurate and contain a!I necessary information.

Alleghany Co., NC
Measure "1001
Length: 1955 feet
Rerimeter. 2049.3 feet _
Area: 3.696 acres
DISCLAIMER: The information contained on this page is NOT to be construed or used as a "legal description". Map
information is believed to be accurate but accuracy is not guaranteed.
http://www.webgis.net Anderson & Associates, Inc. http:!/www.andassoc.com
1 of 1 3/I6/2007 4:I9 PM

~ ~~
1 " 1\
,~
i I % ,. ~.~ .,es
`, ~ f ~ `~ r (~ _w ~,
.. ,, '""~
' ,, , .._ .
~ ~~~.,
'~ ~`

/,f
Y MrJ

Alleghany Co., NC
(4&.o4A>
{2d.8E
~ ~r
{60.76A)
~4
(12A7A)
A)
~r

(2$.47A)'t ti '3.08 `~
0
'
c ,~
c„ 9 v
F;, f 5A) •~ ~
{1 47 j °
2 `~. d ~.68~ [9.28Ai
'~'
6.81 A)

rr ~~
I ~ q h
o t (15.8~A)
> (53.63A)
7 ~( (80.56A}
..-. ~ 1~ 7sa .20A)
{6.58A )
J
' X65
Y '
t ++ 7.30.A
.93A1
4i1 BO
n
{15.54A)
(62.57A)
0 ~1 1-~- y { {6.64A) ,n\.~ ~/~ ~5.7$A) (2's.48A)
} (12.25 t]
~ 1i {1A3A -C .
(~.35A) 1
i ~i ----~ ~i ~ .-1~B.11A)
+ ' ~~~ (1.07 (.50 ) -
r S, ~ , 1 1
~` ~ ~(. {16.70A) {9.29
/ ~ (ti+ (11.98A
0 1ooDn ~~ 1~ ~'b ,t !-' ~ ~ {16.02A)
Parcels
PIN: 4908416041 Deed Acres: 80.560
Subdivision: K5-119 Calc. Acres: 80.560
Owner: Deed Book: 293 Pg: 761
MILES, D. WAYNE JR. & JANET P. Deed Date: 05-12-06
Po aox 727 Misc 1:4908415110
SPARTA NC 28675 Current Land Value:$572,000
Parcel Location: Current Bldg Value: $0
WOODRUFF RO Gurrent Total Value:$572,000
P1N: 4908424418 Deed Acres: 18.440
Subdivision: K5-112A Calc. Acres: 18.440
Owner: Deed Book: 154 Pg: 890
MCKNIGHT, JAMES RUDY & GINA Deed Date: 1992
Po aox 522 Misc 1:490863-650
GLADE VALLEY NC 28627-0522 Current Land Value:$154,300
Parcel Location: Current Bldg Value: $164,000
956 CHERRY LANE RD Current Totaf Value:$318,300
PEN: 4908513151 Deed Acres: 1.090
Subdivision: K5-118 Calc. Acres: 1.090
Owner: Deed Book: 285 Pg: 995
PETERSON, HAROLD EUGENE ET UX Deed Date: 09-15-05
1512 EDGEWOOD DRIVE Misc 1:4908512046
YADKINVILLE NC 27055 Comments: COMBO 9/05
Parcel Location: Current Land Value:$12,800
352 WOODRUFF RD Current Bldg Value: $6,500

Current Total Vaiue:$19,300
PIN: 4908315667
Subdivision: J5-057
Owner:
RASH, KYLE GRANTHAM
371 RASH ROAD
GLADE VALLEY NC 28627
Parcel Location:
37f RASH RD
Deed Acres: 9.281
Calc. Acres: 9281
Deed Book: 204 Pg: 245
Deed Date: 05-01-98
Current Land Value: $85,500
Current Bldg Value: $118,800
Current Total Value:$204,300
PIN: 4907492571
Subdivision: K6-080-005
Owner:
WELLS, CARL DEWEY & NAOMI
245 STELLA ROAD
STELLA NC 28582
Parcel Location:
297 FERNDALE RD
Deed Acres: 4.350
Calc. Acres: 4.350
Deed Book: 165 Pg: 774
Deed Date: 12-14-93
Comments: COMBO 11101-181/728
Current Land Value: $46,400
Gurrent Bldg Value: $62,300
Current Total Value:$108,700
PEN: 4908303646
Subdivision: K6-071
Owner:
GROUSE, DENNIS C. & MARY L.
1073 LAZY BRANCH ROAD
ENNICE NC 28623
Parcel Location:
HAPPY HOLLOW
PIN: 4907495592
Subdivision: K6-080-004
Owner:
CAMPBELL, THOMAS RAY & JO ANN
124 KILLINGSWORTH DRIVE
GARY NC 27511
Parcel Location:
293 FERNDALE RD
Deed Acres: 6.580
Calc. Acres: 6.580
Deed Book: 226 Pg: 906
Deed Date: 04-14-00
Current Land Value:$34,700
Current Bldg Value: $0
Current Total Value:$34,700
Deed Acres: 2.310
Calc. Acres: 2.310
Deed Book: 214 Pg: 741
Deed Date: 03-22-99
Misc 1:4907496521
Misc 2: 4907492296
Current Land Value:$33,300
Current Bldg Value: $64,200
Current Total Value:$97,500
PIN: 4908302299
Subdivision: K6-010
Owner:
GROUSE, THELMA E.
26 GRAPE LANE
GLADE VALLEY NC 28627-9728
Parcel Location:
26 GRAPE LANE
PIN: 4907591789
Subdivision: K5-120
Owner:
MOCK, FLOYD & RUTH
1620 LEWISVILLE-VIENNA ROAD
PFAFFTOWN NC 27040
Deed Acres: 7.300
Calc. Acres: 7.300
Deed Book: 51 Pg: 287
Current Land Value:$70,000
Current Bldg Value: $700
Current Total Value:$70,700
Deed Acres: 5.780
Calc. Acres: 5.780
Deed Book: 234 Pg: 1288
Deed Date: 02-09-01
Current Land Value:$59,800
Current Bldg Value: $0
Current Total Value:$59,800
PIN: 4907397831
Subdivision: K6-011
Owner:
GROUSE, JOHN EDWARD & BERNICE ET AL
51 HAPPY HOLLOW
Deed Acres: 12.250
Calc. Acres: 12.250
Deed Book: 108 Pg: 27
Misc 1:4908303088
Misc 2: 4907395546

GLADE VALLEY NC 28627-9728
Parcel Location:
65 HAPPY HOLLOW
Comments: 210/71 PREVIOUSLY UE
Current Land Value:$108,400
Curren# Bldg Value: $3,500
Current Total Value:$111,900
PIN: 4908502340
Subdivision: K5-119
Owner:
ROYALL, JOHNNY & GLENDA
779 WILEY ROYALL ROAD
THURMOND NC 28683
Parcel Location:
WOODRUFF RD
Deed Acres: 6.460
Calc. Acres: 6.460
Deed Book: 293 Pg: 778
Deed Date: 05-12-06
M isc 1:4908415110
Current Land Value:$52,400
Current Bldg Value: $0
Current Total Value:$52,400
DISCLAIMER: The information contained on this page is NOT to be construed or used as a "legal description". Map
information is believed to be accurate but accuracy is not guaranteed.
http://www.webgis.net Anderson & Associates, Inc. http://www.andassoc.com

y . _. ;:.

Spa
Directions to site:
Take NC Hwy 21 south from Sparta,
pass the Blue Ridge Parkway.
Right onto Cherry. Lane Road and then
right onto Woodruff Road.
Site will be on the right before
cross bridge over Brush Creek.
N
Pro'ect Site /V
I 1

Impact Locations

Legend
Property Line (approximate}
Pond Location
Dam Location
AID 2007-1539-303
~y ~a~
~~ ~'~~ ~. :~. ~:° ZOO l