20040043 Ver 1_COMPLETE FILE_20040113

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
January 22, 2004
Stanly County
DWQ Project #: 04-0043
APPROVAL OF 401Quality Certification with ADDITIONAL CONDITIONS
David & Zeba Barringer
Post Office Box 1165
Mt. Pleasant, NC 28124-1165
Subject Property: Phase I, Lot# 13
Dear Mr. Berringer:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact approximately 344 square feet of waters on Lake Tillery for the purpose of
constructing a boathouse and seawall to stabilize approximately 86 feet of shoreline, as described
within your application dated January 9, 2003. After reviewing your application, we have decided that
this fill is covered by Nationwide Water Quality Certification Number 3373, which may be viewed on
our website at http://h2o.enr.state.nc.us/ncwetlands. This certification allows you to use General
Permit Number 198200030 when the Corps of Engineers issues it. 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. 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 except as
modified below. 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 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) (6) and (7). This approval shall expire when the corresponding
Nationwide Permit expires or as otherwise provided in the General Certification. For this approval to
be valid, you must follow the conditions listed in the attached certification and any additional
conditions listed below.
Conditions of Certification:
Upon completion of the project, the applicant shall complete and return the enclosed
"Certification of Completion Form" to notify DWQ that all the work included in the 401
Certification has been completed. The responsible party shall complete the attached form and
return it to the 401/Wetlands Unit of the Division of Water Quality.
tIU
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), (http:/fh2o.enr.state.nc.us/ncwetlands
Page 2
Mr. Barringer
January 22, 2004
2. This project is for the installation of a seawall to prevent further erosion of the property due to
wave action. The use of mechanical equipment on the beach must be minimized.
3. Equipment and materials may be offloaded to the beach at the bulkhead site, but steps must be
taken to keep all equipment out of the reservoir.
Violations of any condition herein set forth may result in revocation of this Certification and may result
in criminal and/or civil penalties. This Certification shall become null and void unless the above
conditions are made conditions of the Federal 404 and/or coastal Area Management Act Permit.
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 919-733-9646 or Alan Johnson of our
Mooresville Regional Office at 704-663-1699.
Sincerely,
JRD/bs
Attachments
Klime , P.E.
cc: Corps of Engineers Asheville Field Office
Mooresville DWQ Regional Office
File copy
Central Files
1 1
Office Use Only: Form Version October 2001
USACE Action ID No. DWQ No.
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: JAN 1-3 2004
? Section 404 Permit 040^
? Section 10 Permit r ?T?y3
© 401 Water Quality Certification % Wi,ER QUALITY SECTION
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: Er?1hourE -
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/A plicant Information
Name: 72 R-;,,j &c-,- . DI-M, d 2ES,41 r(
Mailing Address: 'P o 2 e g nv- /o/tom nJ C_ 2 / 2 V - / 16
Telephone Number: (`? a y) Y 3 6 - 5 3 3 / Fax Number: 93 E-mail Address: 24--". f JN E'T. ,u E-f-
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:
Fax Number:
Page 5 of 12
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 fmrpos?; 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 project: 9,q44\0us E
2. T.I.P. Project Number or State Project Number (NCDOT Only): --
3. Property Identification Number (Tax PIN): 6,S74 033 Y oS- 9 p
4. Location
County: S fi9?,/y Nearest Town:
_l6FsY,?.
Subdivision name (include phase/lot number): P/, 2 - L t # /3
Directions to site (include road numbers, landmarks, etc.):
At6g c t\ czt
5. Site coordinates, if available (UTM or Lat/Long): --
(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.:distinctmaterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
7. Property size (acres): A
8. Nearest body of water (stream/river/sound/ocean/lake): by L6 7-,112:5
9. River Basin: Vnrd,?,-,
(Note - this mifst be one of North Carolina's seventeen designated major river basins.
River Basin map is available at http://h2o.enr.state.nc.us/admin/mEs/.)
The
Page 6 of 12
10. Describe the purpose of the proposed work:__ 7b ?, hw;lt
-- Sn.^1n • Ti.tp? -
11. List the type of equipment to be used to construct the project: 1,Jo 1%,A4_-
12. Describe the land use in the vicinity of this project: LAke 4o„t A.-"
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.
nlA
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provider justification for the exclusion of this work from the current application:
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.
Page 7 of 12
I. 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***

%i
Al

* List each impact se parately and identify temporary im pacts. Impacts include, but are not limited to: mec hanized clearinQ_ PmAina All
excavadon, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through.the Federal Emergency Man
agement Agency's (FEMA) Flood Insurance Rate Maps
(FIRM),-or FEMA-approved localzfloodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http./ wwww.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?
(please s ify)

* List each im act se aratel d 'd t'
p p y an ten rfy temporary unpacts. 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.tonozone.com,
www:mgMuest.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)
(if Name applicable)
ltcable)
P Type of Waterbody

(lake, pond, estuary, sound,
ba , ocean, etc.)

T -L
. a. __ -=u FY L aVFalalcly auU 1UGUUly tnmpvrary impacts. impacts mciuae, 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 to reduce impacts.
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.
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
htlp://h2o.enr.state.nc.us/ncwetlands/Strmgide.htm].
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.
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 hU://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:
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
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 ? N -
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 ? N
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
(Neese), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No [a 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 i extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
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.
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 [a
Is this an after-the-fact permit application?
Yes ? No ET
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).
Applicant/Agent's Signature) Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
- 7-ask'
Page 12 of 12
LAKE TIL ERY RD.
?ARGy
VICINTY MAP SITE
pat to scale
NOTES,
i BOUNDARY PREDICATED ON EXISTING
MONUMENTATION FOUND IN THE FIELD.
2 AREA COMPUTED BY COORDINATE COMPUTATION.
S PROPERTY IS NOT LOCATED IN A FLOOD
HAZARD AREA.
4 THIS PROPERTY IS IN A COUNTY VHICH
REGULATES THE SUBDIVIDING OF LAND.
5 THIS IS A SURVEY OF AN EXISTING PARCEL
CE' LAND.

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SONNY'S CONSTRUCTION PROPOSAL AND
132" Mneyard Road ACCEPTANCE
NORWOOD, N. C. 28128
Phone [phone]
Pager 063-0434
NRO?OS/1L SNOMtT 0 TO PHONE 3G twh DATE
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CITY. STATE AND I CODE JOB LOCATION
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We hereby submit specifications and estimates for:
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We Propose hereby to furnish material and lobar - compiefe in occordance with above specification
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?aymeof to be ma as follows!

Ea tetttpbl d in a workman-
AN material is guaronreod to b. o• specified. All wpk to
ilkt tltettnM «catding re slonderd praclKes. Any altoratlan or dwtnton from above Authorized
epecilltattene involving extra telly will be ewtcuted only upon "rift" organ, and Signet
will become an extra chargt over and above the tsumatt, All ogrownenis contingent
upon strikes. accidents or delays beyond our c•nke1. Owns to carry fire. tornado Note!. is proposol may be
end other necesseyy Insurance. Our workers are fully teve?ed by workman's Com- withdrawn by us It net accepted wlthin days.
penlow mlyrance.
Acceptance of Proposal - Tht above pules. rp«ilicatlons
•od Conditions are letiltactory and art Itttsby «cepted. You eta authorized Signature
to do the work as specified. Payment will be made as outlined above.
Dom of Accoptance Signoluts
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PouNTE0 IN USA.
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Page 1 of 1
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Help
Legal Disclaimer
Parcel: 657603340590
PIN: 657603340590
Tax Record: 13519
Owner:
BARRINGER ZEBA H & DAVID T
PO BOX 1165
` MT PLEASANT NC 28124
D.B. 932 Pg. 132
P.B. 14 Pg. 40
W.B. 0 Pg. 0
Sale Date 5/20/2003
564,251 k Ir A Acres 1.
1,672,859 Map Width=500' 1,673,359 Land Val: $74,648
Search. IParcel by Owner A Total Val: $74,648
Page generated on 12/15/03 11:31:06 AM Propel----- ,- 13519
DISCLAIMER: Any Information contained on this site is NOT to be construed or used as de facto.
Placement of map data shall under no circumstances be considered as a "legal description". ALL
information is believed to be accurate but accuracy is not guaranteed. Any errors or omissions should
be reported to the Stanly County Geographic Information Systems Division of the Office of
Information Technology. In no event will Stanly County be liable for any damages, including loss of
data, lost profits, business interruption, loss of business information or other pecuniary loss that might
arise from the use of this map or the information it contains.
http://www.webgis.net/STANLY/Cacbe/Pls4V6CC14C7MS.HTM 12/15/03
Page 1 of 1
BARRINGER ZEBA H IVAC RIVER RUN RD 71S ALBEMARLE 1 TWP 1657603340590 1
ILOT 13 1 (RECORD NUMBER:. 13519
8550 COOK ST PO BOX 1165 1 IEASTSIDE FIRE DIST (ROUTE 6576030023
MT PLEASANT NC 28124 I 1 ILISTER:CJ091399
TOPO (STREET UTILITY IZONING FRFT:1-WATENBHD
VACANT 0 LEVEL (PAVED IELECTRICI 1304
I I I NOTES:0,0,40
I I I
#1LAND CLASS I SIZE IBASERATE*FRNT*DPTH*ADJ=ADJRATE*UNITS=LND-VALUE
11 SUWTRFRONTI 86F 261DI 135010.9411.1410.601868.001 861 74648
LAND VALUE: 74648
#10THER FEAT I SIZE IBASERATE*COND =ADJRATE*UNITS=OFB-VALUE
OTHER VALUE: 0
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STRUCTURE VALUE: 0
VALUATION( - VALUEIPREV-VAL.IP-N&1 SALSIS-N&1 TOTAL VALUE 74648
LAND 1 I 746481 373241200&1QU5LFIEDI I
OTHERFEATI 1 1 01 1 1070220021 1
STRUCTURE( I 1 01 1 1 878-7581 1
TOTAL I 1 1 746481 37324120081 750001 99%1
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hq://www.webgis.net/STANLY/files/l/13519.htm 12/15/03
MapQuest: Driving Directions: North America Page 1 of 3
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Start: 179 Tillery Dam Rd
Mount Gilead, NC Book a Hotel:
27306-8724 US Save up to 70% on
Orbitz Savers Nationwide!
End: 49436 River Run Rd
Albemarle, NC Boot: Nov O
28001-7619 US
Distance: 12.29 miles
Total Estimated Time: 29 minutes
Directions
.......................................................................................................................................................................... Distance
.............................
1. Start out going South on NC-1187/TILLERY DAM RD toward NC-731. 0.1 miles
....................
<> 2. ......................................................................................................................................................
731
Turn LEFT onto NC .............................
2.1 miles
.
<?> 3. .....................................................................................................
..
................ ....
Turn LEFT onto NC-1107/NORTHVIEW RD. ...........
.
1.1 miles
....................
4. ......................................................................................................................................................
Turn LEFT onto NC-73/N MAIN ST. Continue to follow NC-73. ............................ .
2.8 miles
.../..`.? ............
4~> 5.
` ......................................................................................................................................................
Turn LEFT onto NC-73. .............................
4.7 miles
...
................
<?> 6. .......................................................................................................
................................ .......
Turn LEFT onto NC-1803/LAKE TILLERY RD. ...........
... .
0.3 miles
....................
- 7.
??? ......................................................................................................................................................
Turn LEFT onto NC-1803/LAKE TILLERY RD. ............................ .
0.8 miles
..............
.
8. ......................................................................................................................................................
Turn LEFT onto RIVER
RD .............................
0.0 miles
. I .......................................................................................
..
End at 49436 River Run Rd, Albemarle, NC 28001-7619 US ...........
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http://www.mapquest.com/directions/main.adp?do=prt&2n=STANLY%2000UNTY& 1 g=V2... 1/9/04
MapQuest: Driving Directions: North America
Page 2 of 3
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Start:
179 Tillery Dam Rd
Mount Gilead, NC
27306-8724 US
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28001-7619 US
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Notes:
....................................................................................................................
All rights reserved. Use Subject to
License/Co vrlc ht
.................................................................................................................... These directions are informational only. No
representation is made or warranty given as to their
.................................................................................................................... content, road conditions or route usability or
expeditiousness. User assumes all risk of use.
........ ............................................................................................. MapQuest and its suppliers assume no responsibility
for any loss or delay resulting from such use.
...................................................................... -.................. ..........................
http://www.mapquest.com/directions/main.adp?do=prt&2n=STANLY%20COUNTY&1 g=V2... 1/9/04
Progress Energy
Progress Energy Service Company, LLC
179 TILLERY DAM ROAD
MOUNT GILEAD, NC 27306
[phone]
APPLICATION FOR APPROVAL FORM FOR SOIL DISTURBANCE ON
PROJECT LAND
RValkways Piers, Boathouses Deck Areas (Over Water Only) Seawalls and Dreduingl
Print or type in all information below and return to Progress Energy Service Company,
LLC 179 Tillery Dam Road, Mount Gilead, NC 27306, [phone]
SECTION ONE BACKGROUND INFORMATION (to be completed by the applicant
1. Full Name (adjoining property owner : T, oGF73A
2. Permanent Mailing Address: /`?- o a - /htA t c i2
3. Local Address (if afferent):
4. Telephone (BuE ell ?YI _34- 93ai(Permanent): y3 6 - 9 y/?? (Local): 791-3 9S_1 5. Fax No. and E-mail (optional):
6. Township: ,5 t}i 4 1t W J, County: tr?.l
7. Lot No.: / 3 Map No.: b5`76IA3YP art: ?_, Addition:
Section: t Phase: Block:
Plat: Unit: Subdivision:
1Flt Bo ol- N P? t? 40
Plat Book and page number: P
USGS Topographic Quadrangle Map: Baft NC Morrow Mountain, NC Mount Gilead
West NC Albemarle, NC (Circle One That Applies)
8. Directions to property (if necessary show location on copy of copy of County road map):
9. What is the designation of the shoreline of the area where soil disturbance is to take place
as shown in Progress Energy's Shoreline Management Plan 73vFl-t A o tx_C
SECTION TWO INFORMATION FOR APPROVAL FORM FOR SOIL
DISTURBANCE ON PROJECT LAND (attach the following to the application)
1. Quadrangle map of the reservoir area where soil disturbance will take place - applicant
must attach a quadrangle map of the area of the reservoir where soil disturbance is
proposed. The quadrangle map must clearly indicate the affected area.
A separate property map must show the following information:
(1) Lot leased by lessee
(2) Progress Energy land between the lot and shoreline
(3) Water area associated with the lot
(4) Allocation lines that determine facilities location and dredging area
(5) Dimensions of area to be dredged
(6) Amount of dredged material to be removed
(7) Description of desired facilities [walkways, piers, boathouses, deck areas (over
water only), seawalls]
(8) Dimensions of desired facilities: [walkways, piers, boathouses, deck areas (over
water only), seawalls]
(9) Existing square footage (water area covered) of water dependent structures
(10)Proposed square footage (water area covered) of new water dependent structure
(11)Maximum distance facilities will extend horizontally into Lake Tillery and cove
widths where appropriate
2. Plan for disposal of dredged material - applicant must attach a written description of their
plans for disposing of dredged material. No dredged material may be disposed of within
the FERC project boundary, or on property owned or managed by Progress Energy
3. Resource impacts assessment - applicant must attach a brief written description of the
potential impacts of the proposed soil disturbance on surrounding reservoir resources,
including impacts to water quality and fish habitat. If there is any vegetation growing in
or around the area of proposed soil disturbance, it should be noted and the areas of
vegetation should be photographed, and included with the application
4. Schedule for conducting the proposed soil disturbance - applicant must attach a written
schedule for completing the proposed soil disturbance
5. Agency Approvals - applicant must attach copies of written concurrence with the
proposed soil disturbance from the following agencies (refer to Instructions for
Application for Approval Form For Soil Disturbance on Project Land
• U. S. Army Corps of Engineers (Seawalls and Dredging)
• North Carolina Division of Water Quality (Seawalls and Dredging)
• North Carolina Departmental of Cultural Resources (All Soil Disturbance
Including Construction of All Facilities and Dredging)
6. Non - refundable facilities approval form fee - applicant must include a check or money
order in the amount of $100 made payable to Progress Energy Carolinas, Inc. for all
construction activities
SECTION THREE (to be completed by applicant
I hereby apply for an approval form to perform the above - described soil disturbance at Lake
Tillery, I agree to abide by all applicable requirements of Progress Energy's Shoreline
Management Plan, the conditions of the Application for Approval Form For Soil
2
Disturbance on Project Land [Walkways, Piers, Boathouses, Deck Areas, (Over Water
Only), Seawalls and Dredging], the Guidelines for the Use of Leased Properties at Lake
Tillery and other Progress Energy procedures and requirements. I also agree that no work
will begin until I receive an Approval Form signed by Progress Energy.

J- 9-o
Applicant's Signature Date
Instructions for Application for Approval Form for Soil Disturbance on Project Land
(Walkways, Piers, Boathouses, Deck Areas (Over Water Only), Seawalls and Dredging)
Instructions
To be considered for an Approval Form for Soil Disturbance on Project Land [Walkways,
Piers, Boathouses, Deck Areas (Over Water Only), Seawalls and Dredging], the adjoining
property owner (or a duly authorized representative) must return to Progress Energy a fully
completed application, letters of concurrence from the appropriate agencies, and a check
made out to Progress Energy for the proper application fee. Please consult Progress Energy's
Shoreline Management Plan and the Guidelines for the Use of Leased Properties at Lake
Tillery for detailed information regarding Progress Energy procedures and requirements
governing activities in the reservoir, along the shoreline or on Company property within the
com)
Project boundary (this information is available online at www.Progress Energy.
Progress Energy will sign and return to you the Approval Form for Soil Disturbance on
Project Land. After Progress Energy has reviewed the documents to ensure that the proposed
activity will be in compliance with the Shoreline Management Plan, the Guidelines for the
Use of Leased Properties at Lake Tillery and all the other applicable Progress Energy
policies, procedures and requirements. You (the adjoining property owner) may not
commence work until such time as you have received from Progress Energy the Approval
Form For Soil Disturbance on Project Land.
Requirements
1. All facilities must be constructed in accordance with the Guidelines for the Use of Leased
Properties at Lake Tillery. The Guidelines can be found in Progress Energy's Shoreline
Management Plan
2. All dredging must be done in accordance with the Guidelines for the Use of Leased
Properties at Lake Tillery
3. All dredging and seawall construction must have prior written approval from the U. S.
Army Corps of Engineers and the North Carolina Division of Water Quality (NCDWQ).
For further information regarding these approvals, you should contact these agencies
directly at the following addresses:
3
Army Corps of Engineers
Montgomery County Stanly County
U. S. Army Corps of Engineers U. S. Army Corps of Engineers
Post Office Box 1890 151 Patton Avenue
Wilmington NC 28402-1890 Room 208
Telephone: [phone] Asheville, NC 28801-5006
Fax: [phone] Telephone: [phone]
Fax: [phone]
North Carolina Division of Water Quality
Montgomery and Stanly County
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh NC 27699-1650
Telephone: [phone]
Fax: [phone]
4. All soil disturbances require prior written approval from the North Carolina
Department of Cultural Resources (NCDCR). For further information regarding this
approval, you may contact the NCDCR at the following address:
1 NC Department of Cultural Resources
State Historic Preservation Office
4617 Mail Service Center
Raleigh NC 27699-4617
5. Facilities may not be constructed in Environmental / Natural Areas
6. Limited facilities may or may not be approved for construction in Impact
Minimization Zones
7. Dredging may not occur during the months of March through June because of
potential impacts to fish spawning
8. Dredging is not allowed in Impact Minimization Zones and Environmental / Natural
Areas
9. Dredging is not permitted in aquatic emergent vegetation beds or other
environmentally sensitive habitat unless extenuating circumstances are involved
10. Dredging may remove only silted material, no rock or hard clay
11. Dredging must be such that water will drain freely from the dredged area when the
reservoir level drops below the level of the dredged area
12. All dredged material must be immediately removed from Progress Energy property
13. Individuals performing the dredging are responsible for disposing of dredged material in
compliance with the rules and regulations of the North Carolina Department of
Environment and Natural Resources (NCDENR). For further information regarding the
disposal of dredged materials, you may contact NCDENR at 919-733-1786
5