20221763 Ver 1_Shoreline Stabilization_20221215

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Quality
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
Submission Form
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email*
[e-mail]
Please provide an email address for payment and requests for more information here.
Pre -Filing Meeting Date Request was 12/13/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
TROY S SIMPSON
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
14842 Rothwell Dr
Address Line 2
City
Charlotte
Postal / Zip Code
28227
Is there an agent working on the project? * Yes
No
Project Information [15A NCAC 02H .0502(a) & (b)]
State / Province / Region
NC
Country
United States
Project Name: * 50095 Fox Rd
If your project has a formal name please use this. If your project does not have a formal name, please identify your project
by the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses
any other names that have been used to identify the project in the past.

1. Provide a vicinity map (i.e. street map) clearly showing the location of the property with respect to
local landmarks such as towns, rivers, and roads. *
Upload File
Look up address
Property Address Lookup: *
Latitude: *
35.313254
Street Address
50095 Fox Rd
Address Line 2
50095 Fox Road
City State / Province / Region
Albemarle NC
Postal / Zip Code Country
28001-7611 US
Longitude: *-80.085423
2. Provide a detailed site plan showing property boundaries and proposed locations of vegetation clearing,
structures (buildings, retaining walls, docks, impervious surfaces, etc.), rip rap, excavation or dredging below
Full Pond/ Normal Water Level elevations, and construction access corridors. You may use the diagram under
section 12.normal pool lake level/normal water level*
SIMPSON-TROY-11-2-22-line added
129.05KB
Shoreline.pdf
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a yard
stick, shovel handle, etc.)
SIMPSON-TROY-11-2-22-line added
129.05KB
Shoreline.pdf
4. Location of the property (where work is to be conducted)
Nearest Town: * Albemarle
County:* Stanly
Lake/ river/ ocean adjacent to Lake
property:
Subdivisions name or site address: *
Tillery Shores 63,64,65 . 50095 Fox Rd
Include phase/lot number
Directions to site: *
NC Highway 24/27 . Take a right before bridege.
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application: *
Home
Residential, undeveloped, etc.
6. Property Size .44
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shoreline work. Put in natural stone/bolders from the area

8. How will the work be done? *
From Land
From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
400
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet land-
ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
100
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet landward to
be impacted:*
(number of trees, for instance)
Mature Trees and undergrowth
Sketch: SIMPSON-TROY-11-2-22-line added
Shoreline.pdf
Application Fee:
129.05KB
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
o $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act");
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
a I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name: * Troy Simpson
Signature:
Submittal Date: 12/13/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20221763 Version: * 1
Select Reviewer: * Andrew Pitner:eads\ahpitner
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?* $240.00
$570.00

smnxo owe
o� n�
m
� n
� � b
� z
bynb
Nbb N��
TF5n.
b9 boby0
A
G
r�m Cy2.
� f �
9l
Shore Line Rip Rat
\ _--------_
y
C.
r„9l 5 od yN���btl
m /
\ v l / ��. L1l 31N90
/ Ntl dWa�
,30
\ \ s
i
N
i�o o�
n ro �m o
hNtl j^zo
n zDNr
�m Nmcxy�
om Aar<`°
z �`y
NOt�nminpl..ir92g
y oz��-a Y m;\ .9%
N No0>ao ','iC13 -8
lam I
o �C)y
N p zmyczi
``I ?`LiC y'1� P '�°• mg
c o� T a• `_ 82
BABE° ON j n
BEPMMBER 19, 1984 •'•?(O R`" �'�a az

smnxo owe
o� n�
m
� n
� � b
� z
bynb
Nbb N��
TF5n.
b9 boby0
A
G
r�m Cy2.
� f �
9l
Shore Line Rip Rat
\ _--------_
y
C.
r„9l 5 od yN���btl
m /
\ v l / ��. L1l 31N90
/ Ntl dWa�
,30
\ \ s
i
N
i�o o�
n ro �m o
hNtl j^zo
n zDNr
�m Nmcxy�
om Aar<`°
z �`y
NOt�nminpl..ir92g
y oz��-a Y m;\ .9%
N No0>ao ','iC13 -8
lam I
o �C)y
N p zmyczi
``I ?`LiC y'1� P '�°• mg
c o� T a• `_ 82
BABE° ON j n
BEPMMBER 19, 1984 •'•?(O R`" �'�a az

smnxo owe
o� n�
m
� n
� � b
� z
bynb
Nbb N��
TF5n.
b9 boby0
A
G
r�m Cy2.
� f �
9l
Shore Line Rip Rat
\ _--------_
y
C.
r„9l 5 od yN���btl
m /
\ v l / ��. L1l 31N90
/ Ntl dWa�
,30
\ \ s
i
N
i�o o�
n ro �m o
hNtl j^zo
n zDNr
�m Nmcxy�
om Aar<`°
z �`y
NOt�nminpl..ir92g
y oz��-a Y m;\ .9%
N No0>ao ','iC13 -8
lam I
o �C)y
N p zmyczi
``I ?`LiC y'1� P '�°• mg
c o� T a• `_ 82
BABE° ON j n
BEPMMBER 19, 1984 •'•?(O R`" �'�a az