19970506 Ver 2_Individual_20131001

Wr, I
® North Carolina Wildlife Resources Commission
Gordon Myers, Executive Director
September 24, 2013
NC DWR, Webscape Unit
512 North Salisbury Street
Raleigh, NC 27604
Dear Sir or Madam:
The North Carolina Wildlife Resources Commission, on behalf of Yadkin County, is applying
to modify DWQ 401 Certification #3149 (WQC Project #970506). Concurrently, NCWRC has applied
to US Army Corps to modify Individual Permit Action ID 199700289.
These Permits were issued for the construction of a dam and the subsequent formation of
Reservoir 5D. The proposed modifications are for water - dependent structures that will be part of
planned Yadkin County Park. Water - dependent structures include 2 floating T- shaped fishing piers
and a boat launch area consisting of a concrete ramp, a sandy beach, and a floating dock to assist
boaters.
Enclosed are site plans, a copy of the Corps Permit application, and additional location data
maps.
The project is located at the end of Crystal Lane in Yadkinville, Yadkin County, NC. Reservoir
5D is in the Yadkin -Pee Dee River Basin. The reservoir was formed by flooding Deep Creek, which
is classified as WS -IV.
This is a phased project. No work on the park has begun. NCWRC will be designing and
constructing these water - dependent structures. A consultant firm will be designing the remainder of
the park and Yadkin County will be responsible for all other construction.
If you need additional information to complete your review, please contact me at
sara.sherman4_)ncwildlife.org or 919 - 707 -0164.
Sincerely,
I;;— '�\_
Sara Sherman, Project Engineer
Division of Engineering Services
SS
Enclosures
DIVISION OF ENGINEERING & LANDS MANAGEMENT
Mailing Address: 1720 Mail Service Center - Raleigh, NC 27699 -1720
Office Location: 1751 Varsity Drive - Raleigh, NC - Telephone: [phone] - Fax: [phone]

Sep 10, 2013 10:38:49 AM
OCP AP DOCUMENT PAYMENT GENERAL INFORMATION DPG
NEXT FUNCTION:
ACTION:
HISTORY: 09/10/2013 10:38:42
BROWSE:
PAY ENTITY
17PT
VEND /EMP NBR: 566000372
40
VEND /EMP SHORT NAME`: DENR)
DOCUMENT NBR: YADKIN090613
DOCUMENT DATE
09/06/2013
PAYMENT NBR: 001
PRTL PYMT NBR: 000
IND AMOUNT
SALES TAX /VAT
VAT INCLUSIVE
N
SALES TAX 2
EXPENSE IND
SALES TAX 3
GL EFFECTIVE DATE:
09/09/2013
FREIGHT
EXTRACT DATE
ADDITIONAL COST
ACCRUAL CANC DATE:
GROSS INVOICE
240.00 CURRENCY CODE
PAYMENT AMOUNT
240.00 DISCOUNT TYPE
NOT TAKEN
AMOUNT — PAID -^
240.003 DISCOUNT TAKEN
.00
PAYMENT STATUS
PAID
PAYMENT TERMS :
NET PAY IMMEDIATELY PAYMENT REF NBR
0000065683
PAYMENT DATE :
09/09/2013
PAYMENT TYPE
ELECTRONIC
PAYMENT ROUTE CD :
HANDLING CODE
FACTOR NUMBER
ONE INVC PER PYMT:
YES
REASON CODE /DESC
BANK ACCT PYMT CD:
IGO

Oil - oso Io U cl,
U.S. ARMY CORPS OF ENGINEERS
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB APPROVAL FEBRUARY 2013
EXPIRES: 28 FEBRUARY 2013
33 CFR 325. The proponent agency Is CECW -CO -R.
Public reporting for this collection of information is estimated to average 11 hours per response, Including the time for reviewing Instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of the collection of information, Including suggestions for reducing this burden, to Department of Defense,
Washington Headquarters, Executive Services and Communications Directorate, Information Management Division and to the Office of Management and
Budget, Paperwork Reduction Project (0710- 0003). Respondents should be aware that notwithstanding any other provision of law, no person shall be
subject to any penalty for failing to comply with a collection of Information if it does not display a currently valid OMB control number. Please DO NOT
RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having jurisdiction over the location of
the proposed activity.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries
Act, Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320 -332. Principal Purpose: Information provided on
this form will be used In evaluating the application for a permit. Routine Uses: This information may be shared with the Department of Justice and other
federal, state, and local government agencies, and the public and may be made available as part of a public notice as required by Federal law. Submission
of requested Information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be issued. One set
of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this application (see
sample drawings and/or instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application
that is not completed in full will be returned.
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE
FILLED BYAPPLICANn
5. APPLICANTS NAME
8. AUTHORIZED AGENT'S NAME AND TITLE (agent is not required)
First - Jason Middle -Paul Last - Walker
First - Sara Middle -J Last - Sherman
Company - Yadkin County Soil and Water Conservation District
Company - NC Wildlife Resources Commission
E-mail Address -jason,[e-mail]
E-mail Address - sara.sherman @ncwildlife.org
6. APPLICANTS ADDRESS:
9. AGENTS ADDRESS:
Address- 209 E Elm Street
Address- 1720 Mail Service Center
Gty - Yadkinville State - NC Zip-27055 Country-USA
City - Raleigh State - NC Zip - 27699 Country -USA
7. APPLICANT'S PHONE NOs. w /AREA CODE
10. AGENTS PHONE NOs. WAREA CODE
a. Residence b. Business c. Fax
a. Residence b. Business c. Fax
N/A 336- 679 -8052 336- 679 -3088
N/A 919- 707 -0164 919 -707 -0162
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, Sara Sherman/NCWRC to act in my behalf as my agent in the processing of this application and to furnish, upon request,
supplemental Information In support of this permit appli ion.
Wk"5'act �l��ri �L- 4 a3 /r 3
SI NATURE OF APPLICANT DATE
NAME, LOCATION, AND DESCR!MT 0bJ ACTIVITY Q
ral
12. PROJECT NAME OR TITLE (see instructions) • + "'-
Yadkin County Park --
13. NAME OF WATERBODY, IF KNOWN (if applicable)
14. PROJECT STREET ADDRESS (If a6LO
Reservoir 5D
Address 1142 Crystal Lane
15. LOCATION OF PROJECT
Latitude: -N 36d 8' 1.37" Longitude: -W 80d 44'42.03'
City - Yadkinville State- NC Zip- 27055
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
State Tax Parcel ID 4887325230 Municipality
Section - Township - Deep Creek Range -
ENG FORM 4345, OCT 2012 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 3

17. DIRECTIONS TO THE SITE
SEE ATTACHED.
18. Nature of Activity (Description of project, include all features)
This application seeks to modify the existing Corps Individual Permit (Action ID 199700289) to include water dependent structures for the
planned Yadkin County Park. The water dependent structures include 2 floating T- shaped fishing piers and a boat launch area. The boat
launch area includes a concrete boat ramp, a sandy beach launch, an 8' -wide floating dock, and rip rap stabilization parallel to the ramp
footprint. The fishing piers include a graded gravel area below the piers to provide level areas to set on and rip rap shoreline stablization
parallel to the pier approaches.
19. Project Purpose (Describe the reason or purpose of the project, see instructions)
This project will be part of a County Recreational Park. The water- dependent structures will provide public access for boating and fishing
on Reservoir 5D. A construction schedule is not yet finalized, but is anticipated to begin in Fall 2013- Winter 2014.
USE BLOCKS 20 -23 IF DREDGED AND /OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
This project will result in areas of fill both in fringe 404 - wetlands and below NWL.
The floating fishing piers will each result in a 8' footprint through the 12' wetland fringe for an impacted area of 240 sq ft each (480 total).
The wetlands fills will be gravel base below the pier and rip rap along either side. The fishing pier structures will not result in any fill
below NWL. Fish attractors will be installed concurrently with pier construction that will be a total fill below NWL of 7 cubic yards.
The boat launch area will result in a 66' footprint through the 12' wetland fringe for an impacted of 792 sq ft. The wetland fills will be
concrete ramp and base, gravel base below the floating dock, sand, and rip rap along either side. The structures will extend a maximum 20'
beyond NWL and will result in fill below NWL of sand, rip rap, and concrete ramp/base.
21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:
Type Type Type
Amount in Cubic Yards Amount in Cubic Yards Amount in Cubic Yards
SEE ATTACHED.
22. Surface Area in Acres of Wetlands or Other Waters Filled (see Instructions)
Acres 1272 square feet = 0.03 acres. SEE ATTACHED.
or
Linear Feet
23. Description of Avoidance, Minimization, and Compensation (see instructions)
Fringe wetlands have developed in the project area since completion of the dam project and creation of the body of water. The project
features are sited in areas where the wetland fringe 12' in width and not in areas with a more gentle slope and wider wetland fringe. The
ramp structures are sited in an area with existing deep water depths in very close proximity to the shoreline, therefore greatly minimizing
the amount of excavation and fill below NWL that will be necessary for boat ramp construction.
ENG FORM 4348, OCT 2012 Page 2 of 3

24. Is Any Portion of the Work Already Complete? Oyes [-]No IF YES, DESCRIBE THE COMPLETED WORK
This application seeks to modify the existing Individual Permit that encompasses the entire darn and reservoir development. The dam
construction and subsequent filling of the reservoir have been completed. A primitive gravel driveway leads to the future park site and dead
ends approximately 40V from the shoreline. No park construction, included the proposed water- dependent structures in this application, has
taken place.
25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (d more than can be entered here, please attach a supplemental usq.
a. Address- See Attached
City - State - Zip -
b. Address -
City - State - Zip -
c. Address -
City - State - Zip -
d. Address -
City - State - Zip -
e. Address -
City - State - Zip -
26. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application.
AGENCY TYPE APPROVAL` IDENTIFICATION DATE APPLIED DATE APPROVED DATE DENIED
NUMBER
' Would include but is not restricted to zoning, building, and flood plain permits
27. Application is hereby made for permit or permits to authorize the work described in this application. I certify that this information in this application Is
complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent of the
applicant.
SIGNATURE OF APPLICANT DATE SI ATURE OF AGENT DATE
The Application 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.
18 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 or
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.
ENG FORM 4348, OCT 2012 Page 3 of 3

Yadkin County Park Project Site
END OF CRYSTAL LANE ON 5D RESERVOIR
GPS COORDINATES:
N 360 8' 1.37"
W 800 44' 42.03•,
DRIVING DIRECTIONS:
1. From intersection of US
601 and US 421 south of
Yadkinville, travel west on US
421.
2. Take Exit 259 for Reavis Rd.
Turn right onto Reavis Rd.
3. Turn left onto Old Us Hwy
421.
4. Turn Right onto Wilcox Rd.
5. Take 1St right onto Ladd Rd. 3
I
6. Continue onto Crystal Lane.
Site is at end of Crystal Lane.
d 1'adYrnv�Se
c GcM,numty fork
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E,

Corp Application Item 21
Types of Materials Being Discharged and the Amount of Each Type in Cubic Yards:
TYPE: CONCRETE RAMP AND BASE
AMOUNT IN CY: 30 CY below NWL
18 CY above NWL in fringe wetlands
TYPE: RIP RAP STABILIZATION ALONG BOAT LAUNCH AREA
AMOUNT IN CY: 6 CY below NWL
8 CY above NWL in fringe wetlands
TYPE: RIP RAP STABILZATION ALONG FISHING PIERS
AMOUNT IN CY: 0 fill below NWL
3 CY above NWL in fringe wetlands (1.5 for each pier)
TYPE1 : GRAVEL BASE UNDERNEATH BOAT LAUNCH AREA FLOATING DOCK
AMOUNT IN CY: 0 fill below NWL
2 CY above NWL in fringe wetlands
TYPE: GRAVEL BASE UNDERNEATH FLOATING FISHING PIERS
AMOUNT IN CY: 0 fill below NWL
4 CY above NWL in fringe wetlands (2 for each pier)
TYPE: SAND
AMOUNT IN CY: 4 CY below NWL
9 CY above NWL in fringe wetlands
TYPE: FISH ATTRACTORS - POLYETHYLENE
AMOUNT IN CY: 7 CY below NWL (3.5 at each pier)
0 fill above NWL
TOTAL FILL BELOW NWL = 47 CUBIC YARDS
TOTAL FILL ABOVE NWL IN FRINGE WETLANDS = 44 CUBIC YARDS

Corp Application Item 22
Surface Area in Acres of Wetlands or Other Waters Filled
TOTAL FRINGE WETLANDS IMPACTS =1272 FT2 = 0.03 ACRES
FLOATING FISHING PIERS:
Piers and gravel base underneath: 192 FT2
Rip Rap parallel to piers : 288 FT2
480 FT2 FISHING PIER IMPACTS
BOAT LAUNCH AREA:
Dock and gravel base underneath: 96 FT2
20' max. width concrete boat ramp: 240 FT2
20' max. width sand beach: 240 FT2
Rip Rap parallel to boat launch: 216 FT2
792 W BOAT LAUNCH AREA IMPACTS
TOTAL FILL BELOW NWL = 47 CUBIC YARDS
TOTAL FILL ABOVE NWL IN FRINGE WETLANDS = 44 CUBIC YARDS

N Property Owners Upstream of Reservoir as of September 10th 2013
A 0 75 150 300 450 600
W Feet
Mapping information is a representation of various data sources and is not a substitute for information that
wnutrl recuR from nn nrcnrate rand curvev to nn avent chatt Yadkin Cnnnty Ptanninn tlanadmant

Site
7 "&
PIN - 488600898173
WOOTEN, SANFORD T ETUX APRIL
3033 W. OLD US 421 HWY
YADKINVILLENC27055
PIN- 489600080982
Yadkin Valley Telephone
PO Box 368
Yadkinville NC 27055
r
;CHEEK MS -4
�W,OLD,US -42
N Property Owners Downstream of Reservoir as of September 10th 2013
0 165 330 660 990 1,320
Feet
Mapping information is a representation of various data sources and is not a substitute for information that
would result from an accurate land survev. In no event shall Yadkin County Planning Department

YADKIN COUNTY PARK
NRCS Soil Survey

YADKI N COUNTY PARK
Google Earth Image
NOTE: USGS Map does not reflect 5D Reservoir that was formed after dam construction.
Google Earth image does reflect the current conditions.

YADKIN COUNTY PARK
USGS Map
NOTE: USGS Mop does not reflect 5D Reservoir that was formed after dam construction
ATION
-11 i 1-1 J,

/ /
100 0 0 00 s
w�
/ Scale 1 " = 100' ' Q
W
O 3
FLOATING FISHING PIER #1 " Z
0
,
IMPACTS: '• W W z
• 8' wide x 12' long wetland fill for fishing pier approach (gravel fill) abo NWL. J r z o
• 6' max width x 12' long wetland fill of rip rap on either side of pi W (J a o N
• TOTAL WETLAND IMPACTS = 240 FTZ a z �"
ZC9 -= o0
• FISHING PIER STRUCTURES REQUIRE NO FILL BELOW c W w o o 0
• FISH ATTRACTORS TO BE INSTALLED CONCURRENT IT PIERS = 3.5 CUBIC YARDS FILL a o W Z 6
UZIM rnrn
� y o W m
J C
Z 0- L
RESERVOIR 5D
BOAT LAUNCH AREA (CONCRETE RAMP, FLOAT DOCK, & SANDY BEACH)
IMPACTS:
• 66' wide x 12' long wetland fill entire footprint above NWL. }�
(20' concrete ramp, 20' sandy beach, 8' gravel below floating d c 9' of rip rap on either side)
• Structures extend maximum 20' beyond NWL
• TOTAL WETLAND IMPACTS = 792 FTz
• TOTAL FILL BELOW NWL = 40 CUBIC YARDS (rip rap and conI ramp /base)
FRINGE 404 - WETLANDS IN PROJECT AREA:
12' WIDTH ALONG SHORELINE, _cc
DELINEATED BY COE STAFF 8/22/2013 p a
0
cc
U
0 O
NWL= ELEV.862.3 C�j
Jad •E
cc
FLOATING FISHING PIER #2 a
IMPACTS:
♦ s • 8' wide x 12' long wetland fill for fishing pier approach (gravel fill) above NWL.
• 6' max width x 12' long wetland fill of rip rap on either side of pier
• TOTAL WETLAND IMPACTS = 240 FT'
FISHING PIER STRUCTURES REQUIRE NO FILL BELOW NWL
�� • FISH ATTRACTORS TO BE INSTALLED CONCURRENT WITH PIERS= 3.5
CUBIC YARDS OF FILL
PERMITS TO BE MODIFIED:
• US ARmy Corps Individual Permit, Action ID 19970 2
• NCDWQ Project 970506, Certification 3149
TOTAL PROPOSED IMPACTS:
• 1272 FT" WETLANDS FILLED 1
• 44 CUBIC YARDS OF FILL IN WETLANDS ABOVE
• 47 CUBIC YARDS OF FILL BELOW NWL
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