20130544 Ver 1_Application_20130522

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20130544
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 seven (7) 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 of to lake bottom of less than 1 acre and $570.00 for impacts to lake bottom of greater
or equal to 1 acre.
Applications should be sent to: d�S
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Division of Water Quality 401 OversightlExpress Review Permittin o�d lels `�''� -1' •
1650 Mail Service Center 3 L
Raleigh, NC 27699 -1650
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I. Applicant Information
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1. Owner /Applicant Information
Name: Char I cs 4 U I oar �l_
Mailing Address: tR h 3 d e iji-�l I nyD CA
f%..� t K' �R, cL.,g nc . � ?3jD
Telephone Number: SE�r Fax Number:
E -mail Address: _ 0rcas to ad, f n 4 orn
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: e ✓ >�R< L>� �s AFa &-X C� -9 JlA kVV.,
Company Affiliation: b
Mailing Address: 6 S 7 % V j ui d
Telephone Number: % d y Y G/ t Fax Number:
E -mail Address: -�6 w f �./ y U t� L-�' i ✓'�6 'ro► LS
MAY 2 2 2013
H. Project Information _L___
Attach a vicinity map clearly showing the location of the property with respect to oc
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.

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1. Location
County: y 0 µe.'1 Nearest Town:
Subdivision name or site address (include phase/lot number):
mi- &rl e-td
1✓ODei O—q,Of
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): Aftt 4 Y L 7
2. Describe the existing land use or condition of the site at the time of this application:taifb✓tJ�e�1
3. Property size (acres): Ys— a e—je e-
4. Nearest body of water ( stream /river /sound/ocean/lake): L& It c Ti I I %ev. w
5. Describe the purpose of the proposed work: ra.a_4•ti )
6. List the type of equipment to be used to construct the project:
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: 3 & 0 % I P/
Ir
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land -ward in square feet or acres:
s
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): Q 41_1
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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 Carolina Department of Cultural Resources
State Historic Preservation Office
Ramona M. Bartos, Administrator
Governor Pat McCrory
Secretary Susan Kluttz
May 13, 2013
Robert Gallagher
Boat Houses on Tillery
10579 Willow Oak Road
Norwood, NC 28128
Office of Archives and History
Deputy Secretary Kevin Cherry
Re: Charles and Judi O'Roark, Soil Disturbance, 312 Fiddlers Ghost Circle, Mt. Gilead, Lake Tillery,
Montgomery County, ER 13 -0885
Dear Mr. Gallagher:
Thank you for your letter of May 2, 2013, concerning the above project.
We have conducted a review of the project and are aware of no historic resources which would be affected by
the project. Therefore, we have no comment on the project as proposed.
The above comments are made pursuant to Section 106 of the National Historic Preservation Act and the
Advisory Council on Historic Preservation's Regulations for Compliance with Section 106 codified at 36 CFR
Part 800.
Thank 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,
Ramona M. Banos

Montgomery County, NC - WebGIS
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