19960425 Ver 1_Complete File_19960503

State of North Carolina
Department of Environment,
Health and Natural Resources A14
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary ID E H N R
A. Preston Howard, Jr., P.E., Director
May 17, 1996
Montgomery County
DEM Project # 960425
APPROVAL of 401 Water Quality Certification
Mr. Charles Roger Staley
101 Grey Fox Run
Rockingham, NC 28379
Dear Mr. Staley:
You have our approval to place fill material in 0.033 acres of wetlands or waters for the purpose
of constructing a pier nd boathouse at Lake Tillery, as you described in your application dated 3 May
1996. 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 or 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,
0 Howard, Jr. P
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Wilmington Field Office
Fayetteville DEM Regional Office
Mr. John Dorney
Central Files
960425.1tr
Environmental Sciences Branch, 4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # [phone]
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State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
Ja mes B. Hunt, Jr., G ove mor
Jonathan R Howes, Secretary
A. Preston Howard, Jr., P.E., Director
FAX TO:
FAX NUMBER:
FROM:
PHONE:
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NO. OF PAGES INCLUDING THIS SHEET:
COMMENTS :

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Environmental Sciences Branch • 4401 Reedy Creek Road Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
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DEM ID: ACTION ID:? . C S
lataionwid Permit Requested (Provide Nationwide Permit #): l-
JOINT FORM FOR n?lh; John ?°?ney
1111
Nationwide per?.ts that require notification to the
Nationwide permits that require application for See
WIL MINGTON DISTRICT ENGINEER WATER QUALITY PLANNIIN
CO S OF ENGINEERS DIVISION OF ENVIRONMENTAL C ,ENT
DE? RTMENT OF THE ARMY NC DEPARTMENT OF ENVIRONM ,
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1890 AND NATURAL RESOURCES
Wil ' gton, NC 28402-1890 P.O. Box 29535 ° MAY 1914h
A77 : CESAW-CO-E Raleiggh, NC 27626-0535
AM MR
JOHN DORN> Y
Tele .
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Telephone (919) -7-3-MOB 13 3 - 1 h 8 WETLAWDS OW
WATER LM,l(TY",'
EERS
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ONE (1) C .
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OPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE C)
SEVEN ( ) COPIES S OULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL, MANAGEMENT.
PLEASE P RINT. _
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1. Owne '
Name:
1 L&El _4 t4 /j 14' 14 In A/
10
t. Owners .
Address:
3. Owners Phone Number (Dome): (Work): 7b
4. If Appl cable: Agent's name or responsible corporate official, address, phone number:

5. Locatio n of work (MUST ATTA,,CH P). County: / V l? LH /? f1?1??Z y
Nearest To wn or City:
Specific
3 SR
cation (Include road numbers, landmarks,'etc.):
`n ?au en nc C- o .
.le U__S P_ /I h ht
6. Name of Closest Stre ver. - r " L ? "T/1 if 7 L1- C-A-
7. River B asin: KZ

8. Is this roject located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS IS S k NO
9. Have a ny Section 404 permits been previously requested for use on this property? YES [ ) NO [ tY
If yes, explain.

10. Estim ated total number of acres of waters of the U.S; , including wetlands, located on project site: ti
w`
11. Num )er of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:
-Drained:
_ rn
Flooded:
Excavated: _
'T'ntal Tm,namobvi• If
t:
APR
12. Descc
AN
13. Puma
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of proposed work (Attach PLANS-8 1/2" X 11" drawings only); } Y 3 a , 02 ??i4?SLL/? S
of
14. Stator ons why the
t en to we anc
e Fs I?
14
15. You ar required to contact the tJI Fish and Wildlife Service (USFWS) and/or National Marine.Fisherles Service
(NMFS? re arding the presence or any Federally listed orrproposed for listing endangered orthreatened ies or critical
habitat m a permit area that may b5 affected by the proposed project. Have you done so? X [ j NO [ ]
RESPONS FROM THE U'SFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You required to contact th,o State Historic Preservation Officer (SHPO) regarding the presence of historic
properties the permit area which may be affected by this proposed project? Have you done so? YES [ ] NO [ ]
RESPONS FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17 *1 Additional information required by DEM,
A. tland delineation map showing all wetlands, streams, and lakes on the property.
B. If vailable, representative photograph of wetlands to be impacted by project.
C. If eiineation was performed by a consultant, include all data sheets relevant to the placement of the
delis ation line.
D. If
E. 1%
R If
stormwater management plan is required for this project, attach copy.
Lt is land use of surrounding property? iPCcaAJ. ZA) AL -- /rt.SIZo-cN 71?h L,
plicable, what is proposed method of sewage disposal? - 7
Owner's Signature Date

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