20210412 Ver 1_Shoreline Stabilization_20210423

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TINE
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 view the form.
Attach documentation of Pre -Filing Meeting Request here:
DWR Pre -Filing Meeting Request Form from
52.37KB
Approval Email.pdf
Pre -fling Meeting or Request Date 2/21/2021
ID# 20210412
I. Applicant Information [15A NCAC 02H .0502(a)]
Version 1
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 email address for payrrent and requests for more information here.
Peter and Jacqueline Ely
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
828 Mallow Place
Address Line 2
City
Charlotte
Rasta) / Zip Code
28270-1322
State / Rovince / Region
NC
Country
US

Is there an agent working on the
project?*
r Yes
C: No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Peter Ely Lake Tillery Rip Rap Installation
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
C: Look up address
Property Address Lookup:*
Latitude:*
35.270600
Street Address
658 Deerfield Rd
Address Line 2
City State / Rovince / Region
Mt. Gilead NC
Fbstal / Zip Code Country
27306 United States
Longitude:* -80.088900
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*
DEERFIELD-SURVEY Shoreline Markup.pdf 44.51KB
DEERFIELD-SURVEY.pdf 141.07KB
RipRap Layout v2 without sea wall.pdf 87.41KB
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.)*
Shoreline photos with tape scale.pdf 764.34KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Mt. Gilead
County: * Montgomery
Lake/ river/ ocean adjacent to Tillery
property:
Subdivisions name or site address:* Eastfork Estates Subdivision
hclude phase/lot number
Directions to site:*

From Fayetteville, per Google Maps directions:
Take Otis F. Jones Pkwy to Green St
2min (0.2nu)
Follow NC-210 N, NC-24 W/NC-87 N and NC-27 W to NC-73 E in
Montgomery County
1 hr 43 min (83.6 mi)
At the traffic circle, take the 2nd exit onto Green St
0.4 mi
Use the left lane to turn left onto Rowan St
0.3 mi
Continue straight to stay on Rowan St
0.3 mi
Turn right onto NC-210 N/Murchison Rd
Continue to follow NC-210 N
Pass by Ruby Tuesday (on the right in 8.9 mi)
9.1 mi
Continue onto NC-24 W/NC-87 N/N Bragg Blvd
Continue to follow NC-24 W/NC-87 N
Pass by Bank of America (with Drive-thru services) (on the left in 1.2
mi)
8.5 mi
Use the right lane to take the ramp to NC-24 W/Carthage
0.6 mi
Continue onto NC-24 W
19.7 mi
Turn left onto US-15 S/US-501 S
1.9 mi
Slight right onto Monroe St
1.2 mi
At the traffic circle, take the 2nd exit onto NC-24 W/NC-27
W/Courthouse Square/McReynolds St
Continue to follow NC-24 W/NC-27 W
41.6 mi
Follow NC-73 E and Lillys Bridge Rd to Deerfield Rd
Rease include road nairea and nurrbers, landrrarks 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
.46 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Existing sea wall is deteriorating. We are seeking a more permanent
approach with large rock rip rap, as the shoreline is eroding.

8. How will the work be done? *
r From Land
17. 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.)
330
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.)
330
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)
No trees will be impacted. 20 feet of elephant grass will be removed.
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
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
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:
Peter Lincoln Ely

Initial Review
Is this accepted into the review C' Yes 0 No
process?*
Project Number:* 20210412
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Version:* 1
Chad Turlington:eads\ccturlington
Fayetteville Regional Office - [phone]
✓ No Payment Needed
✓ Fee Received
C' Need Fee - send electronic notification
C' $240.00
✓ $570.00

N LaAL rl'15JYn.c a CJ!C.ISL.1
5564—DD-41—g7'8 .'
LAKE TILLERY
PHYSICAL SURVEY
FAR
PETER UNCOLN ELY Sc wwf.
JACQUELINE NANTZ ELY
DEED DOi31z E09 PACE F
658 DEERFIELD ROAD
PEE PEE TVI `-1IP
1.1014T OMERY COUNTY, NORTH ::Jsli(tI q
20,020 Square Feet
0_460 Acres
ALL OF LOT 7.-EASTFOR ESTATES
siJBDIVISIDN' A3 RECORDED IN
PLAT C+ti9INET B PAGE 578
11C14TW4ERY MINTY RE I5TRY
SURVEY BY_
SCOTT A. 11ERNEY, PLS
2740 FOWLER ROAD
CONCORD, NC 28025
(704) 793—i4397
TAX ID 5575-15-54-0848
DEED 903K 609 PAGE 23
DATE FEERUFRY 1, 2019
5CI;LE; I — a-0.
CAM FILE IN ERFIELD.DYYC

North Carolina
I, SCOTT ALAN TIERNEY, certify that this plat was drawn under
my supervision from an actual survey made under my supervision
and this map and the survey upon which it is based conform to
the standards of practice for land surveying in North Carolina
(section .1600 of board rules).
SCOTT ALAN TIERNEY REGIS lfi ON No. L-3166
VICINI T Y MAP NOT TO SCALE
NOTES:
1. This map was prepared from a field survey
performed on January 24, 2019 the basis of
bearings is field field tie to found
monumentation as per survey refererence
number one.
2. All distances shown are surface horizontal
distances unless otherwise noted.
3. Areas computed by coordinate computation
method.
4. This map was prepared without benefit of
title report or opinion and does not purport to
show all matters of record of which the
surveyor has no knowledge.
5. Subject tract is Montgomery County tax
parcel 6 575-15— 54— 0848.
REFERENCES:
1. Plat: "Eastfork Estates Subdivision", by T. W.
Harris & Associates, Inc., dated March 13,
1989, and recorded in Plat Cabinet B Page
378, Montgomery County Register of Deeds.
2. Deed Book 609, Page 23, Montgomery
County Register of Deeds. (apparent source of
title)
3. Deed Book 609, Page 17, Montgomery
County Register of Deeds.
EIP 1" PIPE (BENT)
0
N
DUKE PROGRESS ENERGY, INC.
6584-00-41-8718
•♦4,N CAR '*•
♦ ••••••••• _ #1,FESS/Q � #•#_• 0 3: �--7
• i SEAL
L-3166 i • -
• .
0,-,••.� R SU;.•' .
# •.••...•••
•#'*/ ALAN \..♦
Il,HiiiisIS —P
40 80 120
0
9
cP
STUART D. SHELTON & wf.
PENNY H. SHELTON
DB 745 Pg 824
6575-14-44-9829
7S
7
7 7•
7.3'
00
ti
124.11'
0
72 29' 42" W
LAKE TILLERY
EIP #4REBAR
i
P TEIPCAPPED
P
EIP //,RE(BAR
4,
O
FA IEE j D EP
IC R RoADQ
PUB
/W
bet* Q EFK
•
6.7,
cV
4D LOT 2
a. PC B Pg 378
FRANCES M. HUDSON
DB 689 Pg 853
6575-15-54-1825
DRIVE
2.1' S
OF PL
0 EIP
0 NIP
•
R/W
EPK
BC
EP
EG
- P
— SD—
Legend
Existing Iron Pin (found)
New Iron Pin (set)
Computed Point
Property Line Surveyed
Right of Way Line
Centerline
Line Not Surveyed
Right of Way
Existing PK Nail
Back of Curb
Edge of Pavement
Edge of Gravel
Power Pole
Overhead Power Line
Storm Drainage Line
4' Split Rail Fence
Shore Line
Guy Wire
PHYSICAL SURVEY
FOR
PETER LI N COLN ELY & wf.
JACQUELINE NANTZ ELY
DEED BOOK 609 PAGE 23
658 DEERFIELD ROAD
PEE DEE TOWNSHIP
MONTGOMERY COUNTY, NORTH CAROLINA
20,020 Square Feet
0.460 Acres
ALL OF LOT 1, "EASTFORK ESTATES
SUBDIVISION" AS RECORDED IN
PLAT CABINET B PAGE 378
MONTGOMERY COUNTY REGISTRY
SURVEY BY:
SCOTT A. TIERNEY, PLS
2740 FOWLER ROAD
CONCORD, NC 28025
[phone]
TAX ID 6575-15-54-0848
DEED BOOK 609 PAGE 23
DATE: FEBRUARY 1, 2019
SCALE: 1" = 40'
CADD FILE: DEERFIELD.DWG

Top View
lima n .. rntiaur.L-J--1 r I! mr.tiI 1 • 11v.. 1
65134—OD-4' —I- ,. ■ram1
TIAKE TILLEI =-
r
•
ivill."."
20,020 SqL
c4o ,

Side View
10' height
3' water
depth
3' above
shoreline

Ruler is at 4'
View is
looking each
way on the
shoreline

Left photo:
far left of the
shoreline
back towards
dock
Right photo:
closer view
of lack of
vegetation
affected

Left photo:
left side of
the shoreline
showing sea
wall to be
removed
Right photo:
sea wall at
the dock

Panorama view

Dimensions of current sea wall
a Waif

DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210412
Version*
1
Fayetteville Regional Office - [phone]
Chad Turlington
Pre -Filing Meeting Request submitted 2/21/2021
Contact Name * Lincoln Ely
Contact Email Address* [e-mail]
Project Name * Installation of rip rap on shoreline at Lake Tillery
Project Owner* Lincoln Ely
Project County* Montgomery
Owner Address: Street Address
658 Deerfield Rd
Address Line 2
City State / Rovince / Region
Mt. Gilead NC
Fbstal / Zip Code Country
27306 US
Is this a transportation project?* r Yes ( No
Type(s) of approval sought from the DWR:
I— 401 Water Quality Certification - I— 401 Water Quality Certification -
Reg ula r Express
I— Individual Permit I— Modification
rJ Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes ( No
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below.*
We have 100-120 feet of shoreline on Lake Tillery where the existing
sea wall is deteriorating. We want to stabilize the shoreline with large
rock rip rap.
Please give a couple of dates you are available for a meeting.

2/26/2021
2/25/2021
3/2/2021
3/1/2021
Please attach the documentation you would like to have the meeting about.
DEERFIELD-SURVEY Shoreline Markup.pdf
DEERFIELD-SURVEY.pdf
pdf only
44.51 KB
141.07KB
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.
• !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.
Signature
Putr\li)
Submittal Date 2/21/2021