20120132 Ver 1_Application_20120209

20120132
The following is an abbreviated application form for those applying for a 401 Water Quality
Certification to impact FERC (Federal Energy Regulatory Commission) regulated lake shore or
bottom under the U S Army Corps of Engineers Permit GP30 This Application cannot be used
for wetland or stream impacts Please provide five (5) copies of this application and supporting
information as well as a non refundable application fee to the Division of Water Quality of $240 00
for impacts to lake bottom of less than 1 acre and $570 00 for impacts to lake bottom of greater or
equal to 1 acre LDA
r
Applications should be sent to
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699 1650
1 Applicant Information FEB ®9 2012
DENR WATER QUALITY
I Owner /Applicant Information TIANGSMDSTORMWATERBWH
Name e l)no i VZ RUC ' 11
Mailing Address 1-1 l &-� 0 if ( C-1 ks(yn
Telephone Number G)l �' Q0 Fax Number
E mail Address
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 a I� ��n� r al�slUe
Company Affiliation.. Ot i e
Mailing Address 105qq Wi t -tow D4K A( Norwood, NC )- S/-2 X
Telephone Number r�%0Y -113 -06,n16i Fax Number
E mail Address _ hw I d `f (kQ UII(1G��Ye6M o oe -
11 Protect Information
Attach a vicinity map clearly showing the location of the property with respect to local landmarks such
as towns rivers and roads Also provide a detailed site plan showing property boundaries and
development plans in relation to surrounding properties You may use the diagram below to make a
hand sketch of your project Also see the example below for guidance Both the vicinity map and site
plan must include a scale and north arrow The footprints of all buildings impervious surfaces or other
facilities must be included

Location
County �1( Nearest Town NC)( -K)OO "'
Subdivision name or site address (include phase /lot number) 2q S S' ral of ye- I Jvrafojl
nfC
Directions to site please m 'd( road numbers landmarks etc (This is not necessary if an adequate �IW
vicinity map is included) qW �� t� �orw�� fo (e ft DA Ppe I�e Ave rt on
W le400 Take dllee n 4 ep.� + 4o-6— rlq 4 on S ,4 Mf- ors
f ef+
2 Describe the existing land use or condition of the site at the time of this application Pr S eC
3 Property size (acres) r, d -4,0- ->
4 Nearest body of water (stream/nver /sound /ocean/lake)
5 Describe the purpose of the proposed work ►or rl M
6 List the type of equipment to be used to construct the project
7 Amount of impact (including all excavation backfill np rap retaining walls etc) below the
normal pool lake level in square feet or acres
1 "m ou + 3cnt c.4 ) sl�ce���w� 7� -, �, r4-
8 a Amount of impact (including all clearing back fill excavation np rap retaining walls etc )
above the normal pool lake level and 50 feet land ward in square feet or acres
A4f3 h„
8 b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance) i S +1 ^!6 C
F' b V P UM G, I ) L�--d
f.
Applicant/Agent s Signature Date
(Agent s signature is valid only if an authorization letter from the applicant is provided )

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North Carohna Department of Cultural Resources
State Historic Preservation Office
C1 dta B w A t1 g Adrrurustr to
IS ly I I d ( o Off f A h d 11 t Q
I I n( I I S i ry n of 1 1 t a1 It
J ffrCy J( ow 1) 1 ty S t ry I) v1d B k U t
July 20 2011
Robert Gallagher
Boat I louses on "Tillery
10579 Willow Oak Road
Norwood NC 28128
Rt Donald Goodwin Soil Disturbance 399 South Strand Drive Norwood Stanly County L R 11 1451
Dear Mt C allagher
I hank you for your email of July 18 2011 concerning the above project
Wt h I\ c conducted a review of the project and are aware of no historic resources which would be affected by
th( project I herefore we have no comment on the project as proposed
1 he above comments are made pursuant to Section 106 of the N- itional Historic Preservation Act Ind the
Advisory Council on Historic Preservation s Regulations for Compliance with Section 106 codified at 36 Cl It
P-trt 800
I hank you for your cooperation and consideration If you have questions concerning the above comment
please contact Renee Gledhill Earley environmental review coordinator at 919 807 6579 In all future
communication concerning this project please cite the above referenced tracking number
Sincerely
Clamha Brown
L ( 10) L I St t R I g1 NC 27(01 M I g Add 4(17 M I S ry C t R I gh NC 27(99 4617 r I ph /F O19) 807 (570/807 (5 ))

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