20201920 Ver 1_Shoreline Stabilization_20210120

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
55.54KB
(2).pdf
Pre -fling Meeting or Request Date 12/9/2020
ID# 20201920 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 *
Owner Information:
Name: *
Email:*
Phone Number:*
Mailing Address:*
[e-mail]
Rease provide an er ail address for payment and requests for more infornation here.
Robert Brian Beachum
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
49416 Woodland Dr
Address Line 2
City
Norwood
Rbstal / Zip Code
28128
State / Frovince / Region
NC
Country
Montgomery

Is there an agent working on the f Yes
project?* r No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* 1313 Emerald Shores
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.
r Upload File
r Lookup address
Property Address Lookup:*
Latitude:* 35.242000
Street Address
1313 Emerald Shores Road
Address Line 2
City
Mt Gilead
Fbstal / Zip Code
27306
State / Province / Region
NC
Country
US
Longitude:*-80.090969
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*
NC water resources drawings.pdf 117.95KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/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.)*
Shoreline pic IMG-0722.jpg 5.11MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Mount Gilead
County:* Montgomery
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address:* Emerald Shores
Include phasellot number
Directions to site:*
Hwy 73. Right on Lilly's Bridge Rd. Right onto Emerald Shores Rd. Site
is at the end of Emerald Shores Rd. New construction
Reese include road nacres and numbers, landrrarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*

New construction for private use.
Fbsidential, undeveloped, etc.
6. Property Size 0.27
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
New shoreline stabilization is needed due to construction of home and
new dock.
8. How will the work be done? * PF From Land
r- 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.)
700
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.)
1000
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunter of trees, for instance)
Pine and hardwood trees. Normal forest floor. Leaves and under growth.
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
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:* Robert Brian Beachum
Signature:
.�arrr+�t �'tr.?zv rkrrnr

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201920
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Chad Turlingtoweads\ccturlington
Fayetteville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

Sf
State of North Carolina
r Department of Environment and Natural Resources
Division of Water Resources
Water -Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENwaor,r ENTAL ourc,r,v 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
Pond/ Normal Water
Shoreline
Plan View
FORM: SSGP 02-2017
Ae
(At Full Pond/ Normal'Watertevel)
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AAMPLE
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3 ft. below full pand water level 4 ft, above full pond water level 2 ft. additional clearing
'If necessary
Existing bank
10 ft. bank
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FORM: 55GP 02-2017 Page 2 of 2

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DWR Pre-Fil ing Meeting Req u est Form
ID#*Ve rsion *
Re gional Office *
Re v ie we r List *
Contact Name *
Contact Email Addre ss *
Proje ct Name *
Proje ct Owne r *
Proje ct County *
Owne r Addre ss:
Is this a transportation proje ct?*
Type (s) of approv al sought from the DWR:
Doe s this proje ct hav e an e xisting proje ct ID#?*
Do you know the name of the staff me mbe r you would like to re que st a me e ting with?
Ple ase giv e a brie f proje ct de scription be low.*
Please give a couple of dates you are available for a meeting.
20201920 1
Fayetteville Regional Office - [phone]
Chad Turlington
Pre-Filing Me eting Reque st submitte d 12/9/2020
Brian Beachum
[e-mail]
1313 Emerald Shores
Black Sheep Properties
Montgomery
City
Mount Gilead
State / Province / Region
NC
Postal / Zip Code
27306
Country
Montgomery
Street Address
104 North School St
Address Line 2
Yes No
401 Water Quality Certification -
Regular
401 Water Quality Certification -
Express
Individual Permit Modification
Shoreline Stabilization
Yes No
Shoreline Stabilization on Lake Tillery for the new construction of a
home and boat dock.
Ple ase attach the docume ntation you would like to hav e the me e ting about.
Signature
Submittal Date
12/22/2020
12/28/2020
12/29/2020
12/30/2020
1/4/2021
pdf only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:

· This form completes the requirement of the Pre-Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
· I understand by signing this form that I cannot submit my application until 30 calendar days after this pre-filing
meeting request.
· I also understand that DWR is not required to respond or grant the meeting request.

Your project’s thirty-day clock started upon receipt of this application.  You will receive notification regarding meeting location
and time if a meeting is necessary.  You will receive notification when the thirty-day clock has expired, and you can submit an
application.
12/9/2020