20201258 Ver 1_Shoreline Stabilization_20201027

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/22/2020 10:10:43 AM (Submittal)
Submit by Montalvo, Sheri A 10/27/2020 10:55:20 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 10/22/2020 10:11 AM

Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to viewthe form.
Attach documentation of Pre -Filing Meeting Request here:
DWR Pre -Filing Meeting Request Form.pdf 51.52KB
Pre -fling Meeting or Request Date 9/22/2020
ID# 20201258 Version 1
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]
Rease provide an email address for payrrent and requests for pure information here.
Owner Information:
Name: * Alan Scott Broome
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
425 Allen Drive Northwest
Address Line 2
City
State / Frovince / Region
Concord
NC
Fbstal / Zip Code
Country
28027-0798
US

Is there an agent working on the f Yes
project?* r No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Alan Broome 22492-A lot 1
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 acti\Aty (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that ha\je 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.*
F Upload File
r Lookup address
Upload Map: oakwood plat 7 19 20 Survey.pdf 179.58KB
Latitude:* 35.294939 Longitude:*-80.105365
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*
Plan View shoreline.pdf 1.3MR
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.)*
IMG 2879 shoreline pic Jpg 3.76MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Albemarle
County:* Stanly
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address:* 22492-A Oakwood RdLot#1
Include phase/lot nunber
Directions to site:*
Indian Mound Rd to Oakwood rd 22492-A, its the 2nd drive with double
gate (grey)
Rease include road nacres and nunbers, landrrarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential, Undeveloped
Residential, undeveloped, etc.
6. Pro pertySize 2.78
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):

Clearing trees for new 1200sf dock, rip rap 275 linear ft of shoreline as
needed during development
8. How will the work be done?* V From Land
r From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
1125
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.)
1500
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees, for instance)
10-20 trees, to clear for dock access
Sketch: CCE 000038 Shore sketch.pdf 847.93KB
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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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');
0 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:* Alan Scott Broome
Signature:
r{(alL fut AUVIVI

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201258
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

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a State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL QUALITY FORM: SSGP 02-2017
Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
La ke
(At Full Pond/ Normal Water Level)
3'�-/
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Full Pond/ Normal Water Level . dm d •
Shoreline g�
A'p Rap
Plan View
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FORM: SSGP 02-2017 Page 1 of 3

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Side View
ILL.
Lake
(At Fult Pond/ Normal Water Level)
Existing Dock
/30ftx7ft
_ 3ftx 150ff
Below full pond/ NWL
Full Pond/ Normal Water Water Level
r r` "Illorellne _ _ - _ 4fc.lw ft
Riprap At —hull Pond/ NWL
2 ft. x 150 ft.
additional clearing
• if necessary
E AMPLE
Plan View 1
i
FORM: SSGP 02-2017 Page 2 of 3

3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
"If necessary I
Existing bank
10 ft. bank
height
I
Side Vi
FORM: SSGP 02-2017 Page 3 of 3

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9/22/2020
4WCONNECTGIS
ri % N05TING ST4MUNT1
ConnectGIS Feature Report
an,
Stanly
Printed September 22, 2020
See Below for Disclaimer
' i 52 Feet
s map is prepared for the inventory of Real Property found within this jurisdiction, and is compiled from recorded deeds, plats and other public records and date
ers of the map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained o
s map. The Stanly County Geographic Information Systems Division of the Office of Information Technology assumes no legal responsibility for the informatioi
stained on this map. Also, when the deeds and or plats are viewed for a parcel, the Stanly County Register of Deeds Office makes no guarantees regarding th
lection, accuracy, authenticity, or use of these records. The web site is for informational use and convenience only. The Register of Deeds shall in no way be hel
;ponsible for errors or omissions in these records nor for any actions resulting from their use. The official records are kept in the Stanly County Register of Deec
Tice. To view deeds on this site you must install the AlternaTIFF viewer. To install, please visit http://www.alternatiff.com/install-ie/ Warning: City of Norwood: Withi
a city limits of Norwood any improvements such as boathouses or piers that have been built on land owned by Duke Energy are considered to be located on lease
id and therefore will not be found using this program. These improvements are also not considered to be located within the city limits of Norwood and are taxe
cordingly. These leased land records can be identified by going to StanlyTax.com. If a property is located on Lake Tillery in Norwood has a parcel number of 1234 the
a tax bill for the waterfront improvements located on Duke Energy property could be found by placing an LLU1 after the parcel number. On StanlyTax.com search t
rcel / Record number and enter 1234LL01 for this example.
https:/lStanly.connectgis.com/DownloadFile.ashx?i=_ag s_mapcdf11219 606f41 ac8e125d5e40954ccax. htm&t=print 1 /1