20041005 Ver 1_COMPLETE FILE_20040621

Certificate of Completion
DWQ Project No.: o `t' I OQ6 County:
Applicant: J??-X, (XrCi I c? ILL't ? i
Project Name:
Date of Issuance of 401 Water Quality Certification:

Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North
Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certification
I, ltd 6Z J1,d JAJ,:: ( [hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials'.
Signature: / u
RUC
104 DOGWOOD LANE
Agent's Certification MT. GILEAD NC 27306
PHONE [phone]
I, ?/ZOT?-sv , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature: Date:
If this project was designed by a Certified Professional
rr'-1 r= M3
D
MAR 2 4 2005
WETLAN S AND STTOERMWA ER BRANCH
I, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permittee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to be built within substantial compliance and intent of the 401 Water Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature: Registration No.: Date:

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID.: 200401058 County: Montgomery
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner: Rex and Teresa Asbill. Agent: WETLANDS 1401 i% Up
Address: 2665 Winding Woods Lane AUG 1 2 ?oo4
Asheboro, North Carolina 27203
Telephone Number: [phone] WATER ?UALITYS??TIDN
Size and Location of project (waterway, road name/number, town, etc.): 0.007 acres of impact along Lake
Tillery at Lot 36, 382 Springwood Drive, Mount Gilead, Montgomery County, North Carolina.
Description of Activity: to construct a pile-supported 10-foot by 32-foot enclosed boathouse, with an attached
storage shed and approximately 49 linear feet of timber bulkhead not to extend farther than an average distance of
two feet waterward of the lake's normal pool elevation.
Applicable Law: X Section 404 (Clean Water Act, 33 U.S.C. 1344)
Section 10 (River and Harbor Act of 1899)
Authorization: Nationwide Permit Number
30 Regional General Permit Number
Your work is authorized by this Regional General (RGP) or Nationwide (NWP) Permit provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. If your activity is subject to Section 404
(if Section 404 block above is checked), before beginning work you must also receive a Section 401 water quality
certification from the N.C. Division of Environmental Management, telephone [phone]. For any activity
within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone [phone].
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the RGP or NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army RGP or NWP verification does not relieve the permittee of the responsibility to obtain
any other required Federal, State, or local approvals/permits. The permittee may need to contact appropriate State
and local agencies before beginning work.
This verification will remain valid until 5 August 2006 unless the nationwide authorization is modified, reissued or
revoked. If, prior to 5 August 2006 the nationwide permit authorization is reissued and/or modified, this verification
will remain valid until5 August 2006, provided it complies with all modifications. If the nationwide permit
authorization expires or is suspended, revoked, or is modified, such that the activity would no longer comply with the
terms and conditions of the nationwide permit, activities which have commenced (i.e., are under construction) or are
under contract to commence in reliance upon the nationwide permit, will remain authorized provided the activity is
completed within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify, suspend or revoke the authorization.
Action ID.: 200401058
County: Montgomery
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
If there are any questions regarding this authorization or any of the conditions of the RGP or NWP, please contact the
Corps Regulatory Official specified below.
Date 5 August 2004
Corps Regulatory Official Richard K. Spencer Telephone No. [phone]
CF: Jinuny C. Chisholm, Progress Energy
NCDWQ

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DEPARTMENT OF THE ARMY
Wilmington District, Corps of Engineers
Post Office Box 1890
Wilmington, North Carolina 28402-1890
General Permit No. 198200030
Name of Permittee: General Public
Effective Date: July 24, 2000
Expiration Date: December 31, 2004
DEPARTMENT OF THE ARMY
GENERAL (REGIONAL) PERMIT
A general permit to perform work in or affecting navigable waters of the United States and waters
of the United States, upon recommendation of the Chief of Engineers, pursuant to Section 10 of
the Rivers and Harbors Act of March 3, 1899 (33 U.S.C. 403), and Section 404 of the Clean
Water Act (33 U.S.C. 1344), is hereby renewed and modified by authority of the Secretary of the
Army by the
District Engineer
U.S. Army Engineer District, Wilmington
Corps of Engineers
Post Office Box 1890
Wilmington, North Carolina 28402-1890
TO AUTHORIZE MAINTENANCE, REPAIR AND CONSTRUCTION ACTIVITIES IN
LAKES AND RESERVOIRS OWNED, OPERATED AND/OR REGULATED BY PUBLIC
UTILITY COMPANIES AND THE TENNESSEE VALLEY AUTHORITY (TVA) IN THE
STATE OF NORTH CAROLINA.
These lakes and reservoirs were constructed and exist primarily for the purposes of generating
hydroelectric power and/or providing water supply. They were constructed and operated by
public utility companies or under laws and regulations administered by the TVA. Activities within
these waters are the primary concern of, and should be regulated by, these parties. This general
permit applies to all waters on or within lands owned or under flowage easement to public utility
companies and the TVA.
Activities authorized are:
a. Construction of piers, floating boat docks, boat shelters, boat houses, boat ramps, jetties
and breakwater structures and installation of dolphins, pilings and buoys, using commonly
acceptable materials such as pressure treated lumber, unsinkable flotation materials, and confined
concrete.
b. Excavation and maintenance of recreational boat basins and canals/channels where
excavated material is placed and retained on high ground.
c. Stabilization of eroding shorelines utilizing appropriate bio-engineering techniques,
construction and backfill of bulkheads, and the placement of riprap material.
d. Installation of submerged and aerial utility lines where U.S. Coast Guard requirements
for aerial lines are met and preproject elevation contours are restored.
e. Construction of water intake and outfall structures where all State and Federal required
authorizations have been obtained.
1. Special Conditions.
a. Written confirmation that the proposed work complies with this general permit must be
received from the Wilmington District Engineer prior to the commencement of any work. For
this purpose, the proponent should submit detailed plans, location maps, and other supplemental
information explaining the nature and scope of the work.
b. The piers, docks, boathouses and boat shelters will be pile-supported or floating
structures. Mooring piles, dolphins, jetties and breakwater structures may be of wood, metal or
precast concrete. Breakwater structures will be designed to provide for adequate water
circulation landward of the structures.
c. This general permit does not authorize construction across or into any natural or
manmade channel or water body so as to adversely affect navigation by the general public.
d. Piers shall not extend or any other structure be placed further waterward than one-third
the width of a 30-foot wide or greater natural water body designated as navigable pursuant to
Section 10 of the Rivers and Harbors Act of 1899 (i.e., for navigable waterbodies less than 30 feet
wide, pier requests will be evaluated on a case-by-case basis and may be restricted to less than
one-third the width of the waterbody). Docks or piers and adjoining platforms, decks,
boathouses, boat shelters, docks, and "L" and "T" sections will not cumulatively exceed the
maximum allowable size of such structures identified in the reservoir's shoreline management
plan. Docks and piers extending over vegetated wetlands will be elevated sufficiently (minimum
of 4 feet above the wetland substrate) to prevent total shading of vegetation, substrate, or other
elements of the aquatic environment. Floating docks, boathouses and boat shelters will not be
constructed over vegetated wetlands.
e. Wooden jetties will not extend farther than 100 feet waterward of the NWL elevation
contours.
2
f. Boat ramps will not exceed 20 feet in width. No material for construction will be placed
in wetlands. Excavation is limited to the area necessary for site preparation and all excavated
material must be removed to uplands.
g. This general permit does not authorize the installation of fueling facilities on authorized
structures.
h. Decking for piers, docks, boathouses and boat shelters will accommodate loads not less
than 50 pounds per square foot.
i. Wood will be pressure-treated except in areas of boathouses or boat shelters protected
from the weather. Metal or pre-cast concrete pilings are acceptable.
j. Metal pilings or beams will have a minimum section thickness of 3/16 inch.
k. Floating structures will be supported by material that will not become waterlogged or
sink when punctured and will be installed to provide for fluctuations of water elevation and not
break away.
1. Shoreline stabilization activities (bio-engineering techniques, construction and backfill of
bulkheads, and the placement of riprap material) are only authorized along shorelines void of
wetland vegetation, or where construction is accomplished landward of such vegetation. This
general regional permit does not authorize the discharge of dredged or fill material in marsh or
wooded wetlands.
m. Bulkhead and riprap alignments will not extend farther than an average distance of 2
feet waterward, 5 feet maximum, from the normal pool elevation contour and may not extend
more than 500 feet along a shoreline. Riprap will be placed at the base of all bulkheads and will
extend a maximum of three (3) feet waterward on a 2:1 slope.
n. Not more than an average of one cubic yard of fill material per running foot of shoreline
will be placed within waters of the United States.
o. All fill material will be obtained from an upland source and confined landward of
bulkheads.
p. All fill material, including riprap material, discharged into waters of the United States,
must be free from pollutants in toxic amounts. The use of metal products, organic materials,
petroleum base materials or unsightly debris is prohibited.
q. Excavation and removal of accumulated sediment for maintenance of existing basins,
access channels to boat slips and boats slips to previously authorized depths or controlling depths
for ingress/egress, whichever is less, is authorized provided the dredge material is disposed of at
an upland site and proper siltation controls are used. Excavation activities will not occur during
the months of March, April, May, and June because of potential impact to fish spawning areas.
r. Dredging will be limited to channelward of the normal pool elevation. Dredge depths
will not exceed those (depths) of receiving waters channelward of the work.
s. All excavated material will be placed landward of the normal pool elevation contour on
high ground and confined by adequate dikes or other retaining structures to prevent erosion and
sedimentation into adjacent waters or wetlands. Excavation within vegetated wetlands is not
authorized.
t. The temporary placement or double-handling of excavated or fill material waterward of
the normal pool elevation is not authorized.
u. The minimum clearance for aerial power lines will be governed by system voltage as
shown below:
Nominal System Minimum Clearance (ft)
Voltage, Kilovolts Above Bridge Clearances
115 and below 20
138 22
161 24
230 26
350 30
500 35
700 42
750-765 45
Clearances are based on the low point of the line under conditions which produce the maximum
sag considering temperature, load, wind, length, span and type of supports. Clearances for
communication lines, stream gaging cables, ferry cables and other aerial crossings will be a
minimum of ten (10) feet above clearances for bridges. Installation of utility lines will conform to
the special conditions of general (regional) permit No. 198100049.
v. If an easement to fill or cross State, utility company or Federal property is required, such
easement must be obtained prior to commencement of work.
w. If the display of lights and signals on the authorized structure is not otherwise provided
for by law, such lights and signals as may be prescribed by the U.S. Coast Guard will be installed
and maintained by and at the expense of the permittee.
x. It is possible that the authorized structure may be damaged by wavewash from passing
vessels. The issuance of this permit does not relieve the permittee from taking all proper steps to
ensure the integrity of the permitted structure and the safety of moored boats. The permittee will
4
not hold the United States liable for any such damage.
y. This general permit does not authorize any habitable structure or associated facility for
nonwater-related use.
z. This general permit does not apply to structures within existing or proposed marinas. A
marina is defined as any publicly or privately owned dock, basin or wet boat storage facility
constructed to accommodate more than 10 boats.
aa. All work will comply with Water Quality Certification No. 3280, issued by the North
Carolina Division of Water Quality (NCDWQ) on June 1, 2000.
2. General Conditions.
a. All activities authorized by this general permit that involve the discharge of dredged or
fill material in waters of the United States will be consistent with applicable water quality
standards, effluent limitations and standards of performance, prohibitions, pre-treatment standards
and management practices established pursuant to the Clean Water Act (33 U.S.C. 1344) and
applicable State and local law. If the proposed activity involves the discharge of dredged or fill
material in waters of the United States, prior to the commencement of any work, the applicant
will satisfy the North Carolina Division of Water Quality (NCDWQ) regarding the need for a
Water Quality Certification pursuant to Section 401 of the Clean Water Act.
b. There will be no unreasonable interference with navigation or the right of the public to
riparian access by the existence or use of activities authorized by this general permit.
c. The permittee understands and agrees that, if future operations by the United States
require the removal, relocation, or other alteration, of the structure or work herein authorized, or
if, in the opinion of the Secretary of the Army or his authorized representative, said structure or
work shall cause unreasonable obstruction to the free navigation of the navigable waters, the
permittee will be required, upon due notice from the Corps of Engineers, to remove, relocate, or
alter the structural work or obstructions caused thereby, without expense to the United States.
No claim shall be made against the United States on account of any such removal or alteration.
d. A permittee, upon receipt of written notice from the Wilmington District Engineer of
failure to comply with the terms or conditions of this general permit, will, within 60 days, without
expense to the U.S. Government, and in such manner as the Wilmington District Engineer may
direct, affect compliance with the terms and conditions or return the worksite to a pre-work
condition.
e. The permittee must make every reasonable effort to perform the work authorized herein
in a manner so as to minimize any adverse impact on fish, wildlife and natural environmental
values.
f. The permittee must perform the work authorized herein in a manner so as to minimize
any degradation of water quality. The activity will be conducted in such a manner as to prevent a
significant increase in turbidity outside the area of construction or construction-related discharge.
Increases such that the turbidity in the water body is 50 NTU's or less in all rivers not designated
as trout waters by the North Carolina Division of Environmental Management (NCDEM), 25
NTU's or less in all saltwater classes and in all lakes and reservoirs, and 10 NTU's or less in trout
waters, are not considered significant.
g. The permittee will permit the Wilmington District Engineer or his representative to make
periodic inspections at any time deemed necessary in order to assure that the activity is being
performed or maintained in strict accordance with the Special and General Conditions of this
permit.
h. This general permit does not convey any rights, either in real estate or material, or any
exclusive privileges; and it does not authorize any injury to property or invasion of rights or any
infringement of Federal, State or local laws or regulations, nor does it obviate the requirement to
obtain State or local assent required by law for the activity authorized herein. These may include,
but are not necessarily limited to, a Dredge and/or Fill Permit (N.C.G.S. 113-229), a Coastal Area
Management Act (CAMA) Permit (N.C.G.S. 113A-118), an Easement to Fill (N.C.G.S. 146-12)
and a Water Quality Certification pursuant to Section 401 of the Clean Water Act.
i. Authorization provided by this general permit may be either modified, suspended or
revoked in whole or in part if the Wilmington District Engineer, acting on behalf of the Secretary
of the Army, determines that such action would be in the best public interest. Unless subject to
modification, suspension or revocation, the term of this general permit shall be five years. Any
modification, suspension or revocation of this authorization will not be the basis for any claim for
damages against the U.S. Government.
j. This general permit does not authorize the interference with any existing or proposed
Federal project and the permittee will not be entitled to compensation for damages or injury to the
structures or work authorized herein which may be caused by or result from existing or future
operations undertaken by the United States in the public interest.
k. This general permit will not be applicable to proposed construction when the Wilmington
District Engineer determines that the proposed activity would significantly affect the quality of the
human environment and determines that an Environmental Impact Statement (EIS) must be
prepared.
1. This general permit will not be applicable to proposed construction when the Wilmington
District Engineer determines, after any necessary investigations, that the proposed activity would
adversely affect areas which possess historic, cultural, scenic, conservation or recreational values.
Application of this exemption applies to:
(1) Rivers named in Section 3 of the Wild and Scenic Rivers Act (15 U.S.C. 1273),
those proposed for inclusion as provided by Sections 4 and 5 of the Act and wild, scenic and
recreational rivers established by State and local entities.
(2) Historic, cultural or archeological sites listed in or eligible for inclusion in the
National Register of Historic Places as defined in the National Historic Preservation Act of 1966
and its codified regulations, the National Historic Preservation Amendment Acts of 1980 and
1992, the Abandoned Shipwreck Act of 1987 and the Native American Graves Protection and
Repatriation Act.
(3) Sites included in or determined eligible for listing in the National Registry of Natural
Landmarks.
(4) Endangered or threatened species or habitat of such species as determined by the
Secretaries of Interior or Commerce and concerned in accordance with the Endangered Species
Act (16 U.S.C. 1531).
in. Permittees are advised that development activities in or near a floodway may be subject
to the National Flood Insurance Program which prohibits any development, including fill within a
floodway that results in any increase in base flood elevations.
n. At his discretion, the Wilmington District Engineer may determine that this general
permit will not be applicable to a specific construction proposal. In such case, the procedure for
processing an individual permit in accordance with 33 CFR 325 will be available.
o. The permittee or the permittee's successors will maintain the authorized work in good
condition and in conformance with the terms and conditions of the general permit.
BY AUTHORITY OF THE SECRETARY OF THE ARMY:
James W. DeLony
Colonel, Corps of Engineers
District Engineer
w A T? Michael F. Easley, Governor
O?
9
Q William G. Ross Jr., Secretary
O 6 North Carolina Department of Environment and Natural Resources
r
? Alan W. Klimek, P. E. Director
p Coleen H. Sullins, Deputy Director
Division of Water Quality
June 30, 2004
Rex and Teresa Asbill
2665 Winding Woods Lane
Asheboro, NC 27205
DWQ Project # 04-1005
Montgomery County
Page 1 of 3
Subject Property: Fairway Shores Subdivision, Lot# 36, Mt. Gilead, NC
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. & Ms. Asbill:
You have our approval, in accordance with the attached conditions and those listed below, to
place fill within or otherwise impact 0.15 acres of waters and 50 feet of shoreline on Lake Tillery
for the purpose of constructing a seawall and boathouse at'the subject property, as described
within your application dated June 7, 2004 and received by the N.C. Division of Water Quality
(DWQ) on June 21, 2004. After reviewing your application, we have decided that the impacts
are covered by General Water Quality Certification Number(s) 3373 (GC3373). The
Certification(s) allows you to use General Permit Number 198200030 when issued by the US
Army Corps of Engineers (USACE). In addition, you should obtain or otherwise comply with
any other required federal, state or local permits before you go ahead with your project including
(but not limited to) Erosion and Sediment Control, and Non-discharge regulations. Also, this
approval to proceed with your proposed impacts or to conduct impacts to waters as
depicted in your application shall expire upon expiration of the 404 or CAMA Permit.
This approval is 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 the
property is sold, the new owner must be given a copy of this Certification and approval letter and
is thereby responsible for complying with all conditions. If total fills for this project (now or in
the future) exceed one acre of wetland or 150 linear feet of stream, compensatory mitigation may -
be required as described in 15A NCAC 2H .0506 (h). This approval requires you to follow the
conditions listed in the attached certification and any additional conditions listed below.
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and
general conditions of this Certification (or Isolated Wetland Permit) are met. No other
impacts are approved including incidental impacts:
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (htto://h2o.enr.state.nc.us/ncwetlands)
Rex and Teresa Asbill
Page 2 of 3
June 30, 2004
Amount Approved
(Units) Plan Location or Reference
Shoreline 50 (feet)
Waters 0.15 (acres)
2. Erosion & Sediment Control Practices
Erosion and sediment control practices must be in full compliance with all specifications
governing the proper design, installation and operation and maintenance of such Best
Management Practices in order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed,
installed, operated, and maintained in accordance with the most recent version of the
North Carolina Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion
control measures must be such that they equal, or exceed, the requirements specified
in the most recent version of the North Carolina Sediment and Erosion Control
Manual. The devices shall be maintained on'all construction sites, borrow sites, and
waste pile (spoil) projects, including contractor-owned or leased borrow pits
associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be designed,
installed, operated, and maintained in accordance with the most recent version of the
North Carolina Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in
accordance with the requirements of the Sedimentation Pollution Control Act.
3. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas
beyond the footprint of the impacts depicted in the Pre-Construction Notification. All
construction activities, including the design, installation, operation, and maintenance of
sediment and erosion control Best Management Practices, shall be performed so that no
violations of state water quality standards, statutes, or rules occur.
4. No Sediment & Erosion Control Measures w/n Wetlands or Waters
Sediment and erosion control measures shall not be placed in wetlands or waters to the
maximum extent practicable. If placement of sediment and erosion control devices in
wetlands and waters is unavoidable, they shall be removed and the natural grade restored
within six months of the date that the Division of Land Resources has released the
project.
5. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or
applicable Buffer Rules, and any subsequent modifications, the applicant is required to
Rex and Teresa Asbill
Page 3 of 3
June 30, 2004
return the attached certificate of completion to the 401/Wetlands Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
Violations of any condition herein set forth may result in revocation of this Certification and may
result in criminal and/or civil penalties. The authorization to proceed with your proposed
impacts or to conduct impacts to waters as depicted in your application and as authorized by this
Certification, shall expire upon expiration of the 404 or CAMA Permit.
If you do not accept any of the conditions of this Certification (associated with the approved
wetland or stream impacts), 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, 6714 Mail Service Center, Raleigh,. N.C. 27699-6714. 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 Cyndi Karoly in the Central Office in
Raleigh at 919-733-9721 or Ken Averitte in the DWQ Fayetteville Regional Office at 910-486-
1541.
Sincerely,
Alan W. Klimek, P.E.
AWK/bs
Enclosures: GC 3373
Certificate of Completion
cc: USACE Wilmington Regulatory Field Office
DWQ Fayetteville Regional Office
File Copy
Central Files
Filename: DWQ# 004-1005 - Rex & Teresa Asbill (Montgomery) 401
.,A
It
Office Use Only: 6 %j) [ Form Version October 2001
USACE Action ID No. DWQ No. ;,J
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1.
Processing WETLANDS / 401 GROUP
1. Check all of the approval(s) requested for this project: JUN 2 1 2004
Section 404 Permit WATER QUALITY SECTION
? Section 10 Permit
GZ401 Water Quality Certification
? Riparian or Watershed Buffer Rules pp i?
2. Nationwide, Regional or General Permit Number(s) Requested: Iq 0 aQ?Q3?
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ? N/)?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ? K/ A-
11. Applicant Information
1. Owner/Applicant Information
Name: Rent ae?d `1
Mailing Address:-?A?S,?
Telephone Number:
E-mail Address: 1"Q7lWi-i
Fax Number:
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:
E-mail Address:
Page 5 of 12
Fax Number:

III. 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. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of proj
2. T.I.P. Project Number or State Project Number (NCDOT Only): "/A
3. Property Identification Number (Tax PIN): 17T7t y"
4. Location
County: Mont f rf Nearest Town: Mf • G/ I eao- N. C .
Subdivision nam (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.). 13 -r-JD
m d
a k, pri uJ? ?,
Rt,PrWu.y Shares Ndr h o4ratia- C, n a h Q ho
5. Site coordinates, if available (UTM or Lat/Long): hO{" A V Q, I J 0_, J b
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
7. Property size (acres):
15
8. Nearest body of water (stream/river/sound/ocean/lake): Lake Tip II enA
9. River Basin: VL[.? Kl (?
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/mal2s/.)
Page 6 of 12
10. Describe the purpose of the proposed
11. List the type of equipment to be used totconstruct the project:
12. Describe the land use in the vi cinity of this project:
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application:
/)/A
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet. N/A
Page 7 of 12

1. Wetland Impacts
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htty://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
specify)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
,
www.usgs.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coin
www.mWguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12

3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)
BLL S La Ti 1

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction duce impacts.
AJ/
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams. NIA
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
httj2:Hh2o.enr.state.ne.us/ncwetlands/strmgide.htmi.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
NIA
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wm/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N /,A
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No 2/
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
N/lk
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property. NIA
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application? l
Yes ? No ?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
,--Qw W&UaX
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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Survey for :
REX ALLEN ASBILL & WIFE,
TERESA MARLEY ASBILL
Lot No. 36, Map No. 7 of the FAIRWAY SHORES Development
Pee Dee Township, Montgomery County, North Carolina
Deed Reference Book 193 Page 593; Plat Book 4 Page 71.
Surveyed by Thomas J. Fields, PLS-2906, on April 13, 2004.
REVISED & UPDATED on May 12, 2004.
TOTAL AREA = 0.15 Acre f
by coordinates
30 0 30
Scale is in Feet
1 "= 30'
From the office of
WRIGHT & FIELDS LAND SURVEYING
1340 Albemarle Road, Suite C
Troy, N.C. 27371
of 00.
L
Tie Line
N 30'51'10"
Found: 16.00 FT
1/ Iron 0 J
Pipe
Found: 3/4" \ r
Iron Pipe \ MAGNETIC
,G\? \ NORTH
? \ April 2004
s\P \
?o
Found:
5/8" Iron
Rod
3
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yy 5 '06
Fast Set- 'Iron Rebar ?+ c

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\ Ile'
NORTH CAROLINA
MONTGOMERY COUNTY
?0 ?-
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-Alb 5ro Found:
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Found:
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Found:
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I, Thomas J. Fields, certify that this plat was
prepared from an actual survey done by me in
April 2004 and is in all respects correct
to the best of my knowledge and belief. The
ratio of precision as calculated by latitudes and
departures is 1:20.000'+ . This plat was
prepared in accordance with Board Rule .1600
Witness my original signature and official stamp
this the 12th day of - May 2004
A
PLS-2908
u' ?• Oz ??4f4)?C ?Q,
No horizontal control within 2000 feet.
NOTE: This property is not located in any FEMA special flood hazard area.

?

NOTE: This survey is based on data
take
n from the on inal subdivision plat
of F
airway Shores ( Map No. 7 ) dated
April
1966 and recorded in Map Book 4
Page
71 and existing monuments found
at th
e site. Any differences between
drawing and the original subdivision
plot
could be in the use of more modern
and
accurate instrumentation as compared
to the equipment available in 1966. .
Legend
O ...... denotes monuments found
or set as noted on plat.
Job No. 2004-77
Mmnf b lw ti 161