19970411 Ver 1_COMPLETE FILE_19970508

DEM' ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):

PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
970411 1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
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3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT?9 ?9y,
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SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE 4'
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN 0
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME : / I L L / A
2. MAILING ADDRESS:
SUBDIVISION NAME: ((Alzf ?Q1-+jy-7- ez--AcA
CITY: IVO /\ Z4,) d0 )?) STATE: /V e , ZIP CODE: 41D /,< PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE) : ?n l /9 ?7 L fq "y
3. TELEPHONE NUMBER (HOME) : `7O ? 421Q3)`j' (WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: L /-) At 'D D W N,?,_ R _?r / 4 4 L-D D (4 7- F6 Km 5-
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGR_AP Y WITH SCALE) :
s V
COUNTY : S7- N)- `° NEAREST TOWN OR CITY:
CORPS ACTION ID:'
1

PECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.):
6. IMPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN: Y 4 D /? /vV
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW7 , WATER
SUPPLY (WS-I OR WS-II)? YES [ ] NO---A] IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO -[,*,]
7c. IF THE PROJECT IS LOCATED WITHIN A'COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
'A/IA
Sa. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO -fAl IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO 1[`I IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: LOIL •??
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
2

10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING:
FLOODING:
EXCAVATION:
? 0 03-;-
OTHER:
DRAINAGE:
TOTAL ACRES TO BE IMPACTED:
-18b3'p-
,V/A 10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION) :
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER:
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) : Mo /t/L G o r / C L C- a41 P 7-6 t31= "115 Aar D
a" A-')/ate A/ H/G ? ?o'L 6 /v C-
13. PURPOSE OF PROPOSED WORK:
3
v"
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND GSJ?V?s
IMPACTS) : d S I D Iil /? U e T U &,,/ 49 1Y"'` A c-. 1-1 d r1' /'-5
?-os5 0l= sHd?? L °L/ly !?P X14 yL-7 R
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. RDATE
ESPONSES
CONTACTED: (ATTACH
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES [3 NO --A (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ 3 NO [ 3
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [I NO [ 3
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
/
INCH EQUALS 100 FEET OR THEIR EQUIVALENT. ?S C J'/ ;?P U SLED IN Qtl?ST / 'L/
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT. ?fJd 7'4 1V O T- ) /9 d L- kf
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE,, OWNS { ?P),D M A P
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED. /VIA
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? SUf,O?ly151 D
ArP fl ;FZ fzE )-/,I rN) H I- ttS 4==-
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
s ep i l < rA 1v k ?-- OFi H ov L. / rv L
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE. W"?
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
OWNER'S/AtElIr'S SIGNATURE
'Lzs/ ?71
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
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i THIS IS TO .C[RTIFY THAT ON THE DAY OF ID 1 SURVEYEC ,THE
PROPF"TY -SHOWY ON THIS PLAT. AND THAT THE PROPERTY LINES. WALLS, /1ND BUILDINGS ARE AS 'SHbWN-
HEWON: THAT TM, K BUILDINGS LOCATKD ON SAID LOT DO NOT ENCROACH OR -PROJECT ON ADJACENT'STRE&s
OR PROPERTY:. AND THAT NO ADJACENT BUILDINGS OR WALLS ENCROACk pit PROJECT ON SAID PREMISES:
"DAVID R. LANTER
STONED `
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
APPROVAL of 401 Water Quality Certification
Mr. William S. Griffin
P.O. Box 1284
Norwood, NC 28128
Dear Mr. Griffin:
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[D EHNR
May 20, 1997
Stanly County
WQC 401 Project #970411
You have our approval, in accordance with the attached conditions, to fill in 0.0032 acres of wetlands or
waters for the purpose of bank stabilization at Lake Tillery, as you described in your application dated 8 May
1997. After reviewing your application, we have decided that this fill is covered by General Water Quality
Certification Number 3099. This Certification allows you to use General Permit Number 030 when it is
issued by the Corps of Engineers. In addition, you should get any other federal, state or local permits before
you go ahead with your project including (but not limited to) Sediment and Erosion Control, Coastal
Stormwater, Non-Discharge and Water Supply Watershed regulations. Also this approval will expire when
the accompanying 404 or CAMA permit expires unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application. If you
change your project, you must notify us and you may be required to send us a new application. If total
wetland fills for this project (now or in the future) exceed one acre, compensatory mitigation may be required
as described in 15A NCAC 2H .0506 (h). For this approval to be valid, you must follow the conditions
listed in the attached certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing.
You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written
petition which conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. This certification and its conditions
are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone John Dorney at 919-733-1786.
Sincerely,
l ston Howard, Jr. P. .
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Field Office
Mooresville DWQ Regional Office
Mr. John Domey
Central Files
970411.1tr
Division of Water Quality • Environmental Sciences Branch
Environmental Sciences Branch, 4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # [phone]
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