20231182 Ver 1_Shoreline Stabilization_20230825

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 8/22/2023
submitted on: *
Owner Information:
....................................................................................
Name: *
Email: *
Phone Number:
Mailing Address: *
Tommy and Elizabeth Blake
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
PO BOX 224
Address Line 2
City
Candor
Postal / Zip Code
27229
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Robert Gallagher
Lakeside Contractors
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
USA

Mailing Address: *
Street Address
726 Berry Hill Drive
Address Line 2
City
Norwood
Postal / Zip Code
28128-6576
A signed and dated copy of the Agent Authorization letter:
Scannable Document on Aug 24, 2023 at 10-28-13 AM.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Thomahawk Shoreline
State / Province / Region
NC
Country
US
418.18KB
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
Upload Map: ... ...
Latitude: * 35.330510
Longitude: *-80.068940
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*
1... ...
Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/o/edoc/616616/Shoreline%2OLayout.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.)
I... ...
4. Location of the property (where work is to be conducted)
Nearest Town: * Troy
County: * Montgomery
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address: * Woodrun on Tillery (Lot 760 &761)
Include phase/lot number

Directions to site: *
From 24/27 take a left on River Rd. Make a left on Woodrun Drive to enter Woodrun on Tillery. From the gatehouse, continue on
Woodrun Dr until you come to the end of the road. Take a right on Fairfield Drive and then a left on Thomahawk Court. Home is
on the right.
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:
residential
Residential, undeveloped, etc.
6. Property Size .93
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shoreline stabilization is needed from the lake waves
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.)
500
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.)
1200
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)
There are a few small trees
Sketch:
Application Fee:
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
d $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
d 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');
d 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Robert Gallagher

Signature:
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Submittal Date: 8/24/2023

Initial Review
Is this accepted into the review process?* Yes O No
Project Number: * 20231182 Version:*
Select Reviewer: *
Select Reviewing Office
Has payment been received?*
What amount is owed?*
Chad Turlington:chad.turlington
Fayetteville Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification
$240.00
$570.00