19950681 Ver 1_COMPLETE FILE_19950103

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
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July 7, 1995
Montgomery County
DEM Project # 95681
APPROVAL of 401 Water Quality Certification
Ms. Agnes D. Ingram
102 Sunrise Avenue
P. 0. Box 535
Mount Gilead, N.C. 27306
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Dear Ms. Ingram:
You have our approval to place fill material in waters for the purpose of enlarging a present
boathouse at Lake Tillery, Fairway Shores - South (Lot # 22, Section A), as you described in your
application dated 28 June 1995. After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Number 2674. This certification allows you to use
General Permit Number 030 when it is issued by the Corps of Engineers.
This approval is only valid for the purpose and design that you described in your application. If
you change your project, you must notify us and you may be required to send us a new application.
For this approval to be valid, you must follow the conditions listed in the attached certification. In
addition, you should get any other federal, state br local permits before you go ahead with your
project.
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 Environmental Management under Section 401
of the Clean Water Act. If you have any questions, please telephone John Dorney at 919-733-1786.
Sincerely,
A. Preston Howard, Jr. P.E.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Wilmington Field Office
Fayetteville DEM Regional Office
Mr. John Domey
Central Files
95681.1tr
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper

DEM ID: Gf 5 ($/ ACTION ID: 401 ISSUED
Nationwide Permit Requested (Provide Nationwide Permit ft
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
.Nationwide permits that require application for Section 401 certification
WIL GTON DIS T ENGINEER WATER QUALITY PLANNING ' , tomt; ??
CORP OF ENGI RS DIVISION OF ENVIRONMENTAL MA?tMEN?' °=r
DEPAR THE ARMY NC DEPARTMENT OF ENVIRONMEItALTH
P.O. Box 1 AND NATURAL RESOURCES Jul ? J J?A $
Wilmi n, C 28402-1890 P.O. Box 29535
A : CESA -CO -E Raleigh, NC 27626-0535 > r
Te ephone (919) 1-4511 ATTN: MR. JOHN DORNEY'
Telephone (919) -733 508a ? 3 3 -
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
PLEASE PRINT.
1. Owners Name: trf G Al 9 S T. T N A k A M
2. Owners Address: I o a S u n1 r s A v P. P.a.sa x s- i 5 M+, G i L as d N. C. a -7.3,6
3. Owners Phone Number (Home): 1 t a - 4 3 9 - b S'.23 (Work):
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP). County: N 6 (V a n m e rc U
Nearest Town or City:
Specific Location (Include road numbers, landmarks,'etc.): r-- A i R a 4 S h o e s- S? l b,
- a1 glc :x 2 Sec..- A
6. Name of Closest Stream/River:
7. River Basin:
8. Is. this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS II? YES [ ] NO [ ]
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [z]
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site:
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:
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12. Description of proposed work (Attach PLANS-8 1/2" X 11" drawings only): W(? 1901,69
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13. Purpose of proposed work: -= e v / 4 e n Y e s ,vf la o a f l a se ?o a ?o n, '? ?l R Fe
IautLem ®a+
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts.
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine.Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat in the permit area that maybe affected by the proposed project. Have you done so? YES [ ] NO ( ]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the, State Historic Preservation 'Officer (SHPO) regarding the presence of historic
properties in the permit area which maybe affected by the proposed project? Have you done so? YES[ ] NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property?
F. If applicable, what is proposed method of sewage disposal? -(aTA.V k
Owner's Si ature Date

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