20210600 Ver 1_Shoreline Stabilization_20210528

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.pdf 56.04KB
Pre -fling Meeting or Request Date 3/19/2021
ID# 20210600
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 payment and requests for more information here.
Kenneth W Carothers
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
48373 W Wind Way
Address Line 2
CitY
Norwood
Rbstal / Zip Code
28128-7459
State / Rovince / Region
NC
Country
United States

Is there an agent working on the
project?*
r Yes
C: No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Carothers Shoreline
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.*
F Upload File
r Look up address
Upload Map: Carothers PCN 8.pdf 448.O1KB
Latitude:* 32.255830
Longitude:* -80.103890
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*
carothers site plan.pdf 554.63KB
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.)*
Carothers PCN.pdf 3.6MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Norwood
County:* Stanly
Lake/ river/ ocean adjacent to Tillery
property:
Subdivisions name or site address:* 48373 W Wind Way Norwood NC 28128 Lot #4
hclude phase/lot number
Directions to site:*
From Norwood Police Department - head south on 52 and TL onto Pee
Dee at Uwharrie Bank. Travel Pee Dee (turns into Indian Mound Road)
and TR onto Randalls Church Road. TL onto Randalls Ferry and TL onto
Wind way.
Rease include road nacres and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
residential - improved
Residential, undeveloped, etc.
6. Property Size
1.5 acres
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
install class II rip rap along shoreline
8. How will the work be done?*
17 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.)
543 @ 6' below full
pont
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.)
543 @ 6' above full
pond
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)
normal residential manicured lawn, trees and vegetation
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:
Kenneth W Carothers

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210600
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Version:* 1
Alan Johnson:eads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
C' Need Fee - send electronic notification
C' $240.00
r $570.00

North Carolina, Stanly County
1 Miehoel R_ Ingram _ Codify Thal This plot was drawn under rod direrl
supervision from an arl nal weeny made under my direrl snl,ervisinn from deed
lesrrip, ions recorded os follows:
D.B. 1638, PG.360 / PIN:657401094877
Lot II 94 / P.B. 5, PG. 205
That the boundaries not s.uveyed are ,lead, indicated as dashed lines as
drawn from information of record as shown hereon. That the Ratio of -Precision
as calculated is 1 / 10,000+, That this plat was prepared in accordant, with G.S.
d 7-30 as amended. Witness my hand and Official Stamp or Seal.
Michael R. Ingram
cask -mat Lant0 Su
rcy
9/25/21
orp L4171 Datc
SURVEY STATUS
1. That the survey is of an existing parcel or parcels of land
and doe_, not create a new street or change an existing sweet_
THIS MAP MAY NOT BE A CERTIFIED SURVEY AND
HAS NOT BEEN REVIEWED BY A LOCAL
GOVERNMENT AGENCY FOR COMPLIANCE WITH
ANY APPLICABLE LAND DEVELOPMENT
REGULATIONS AND HAS NOT BEEN REVIEWED
FOR COMPLIANCE WITH RECORDING
REQUIREMENTS FOR PLATS.
BELINDA J. CROWELL
LEGEND
These standard symbols will
be found in the drawing.
• IRE - Iron Rod Pound
0 IRS - Iron Rod Set
0 IPE - Iron Pipe Found
® MNF - Mag Nail Found
® M. = Mag Nail Set
® NSCL= Nail Set Centerline
® NFCL - Nail Found Centerline
. CMF= Concrete Monument Found
• CMS - Concrete Monument Set
O CC= Computed Corner Not Set
PP - Power Pole
Boundary Line
Got Line — — — — —
Shoreline
N/E - Now or L,,,,,,ly
OHP - Overhead Power Line
OHO = Overhead Utilities
Notes: (x if applicable)
X' 1. No NC Grid "Found" within 2000' of this Site
X 2. All distances are horizontal field measurements
and are not adjusted by a Grid factor.
3. Portion of this property lie.. within a Flood Prone Area,
Map 0
Dffectivc Bate:
X 4. Area computed by Coordinates.
5
State of North Carolina, County of: Stanly, Review Officer
Review Officerof Sturdy County,
Certify that this Map or Plat to which this Cervficaba,, is affixed
meets all Statutory Requirements for Recording.
Review Officer Date
7
ft R'
2
$o
4
\ 24 Concrete darker
a ln'. Base of Lg.'Tree
C-C
a o0
ov o 550.348.A7 Mt
Er 1,670,430.62 sff
6avva �y3
CC" Within Le_ Oak
ry5a'
wry
Concrete Marke.
Top Broken off
N. 550,273.55 sit
F._ 1,670.3274.3 sfr
D.B. 778, PG. 01 � 1 i 93
Lot #93 7
P.B. 5, PG. 205
PIN: 657503003134
L
\
\
i—N \
\95) \
WARD H. CAGLE \
D. B. 1173, PG. 448
D.B. 359, PG. 106
Lot # 95
P.B. 5, PG. 205
PIN:657503004038 /
\ p4 Rehar Found
\ n-Line (a, 40.8`'
I I \4" IPF
Boat House
Tie Lin
' 5 14'26 12' E
30.0'
Concrete Marker'
Top Broken off
Lake 'Tillery
1,
Boot Shed
WARD H. CAGLE
D.B. 1173, PG. 448
D.B. 372, PG. 441
Lot # 94 - A
P.B. 5, PG. 205
PIN:657503004038
Concrete. Marker
d Base of Power Pole
ffe
1 1\4' IPF Ss
\
a/!
— \2IPE
S 34, �� 8T 52
79'26
-•.1
Nsrd
W E
Dixie Land Surveying, PLLC
License: P-0335
4278 Country Club Road, Wadesboro, N.C. 28170
phone: [phone] / email: [e-mail]
Lake Tillery --
Duke Energy
Progress, Inc.
11 \4'IPF
Lake Tillery
I \4'IPF
NAD 83
GPS
NAD 83 Convergence;-0.63748333°
Combined Factor_ 0.99986362
All Coodinates Shown heron
SPC / ZONE 3200 NC
NAD 83/ 2011 Posaion
Scale: 1" = 50'
0' 30' 60' 90'
Plot Scale : 1 inch = 100 ft.
0.69 AC
29842.9 SF
Plat of Property Surveyed for:
GO
Kenneth W. Carothers
Center Twsp., Stanly County, N.C.
Located at; 48373 W WIND WAY
For Reference See;
D.B. 1638, PG.360 / PIN:657401094877
Lot # 94 / P.B. 5, PG. 205
Date:05/25/21 - Drawn By: MRI - File # : 15521

ROY COOPER
Governor
MICHAEL S. REGAN
Secretory
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
State of North Carolina
Department of Environment Quality
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 09-2020
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Paul Wojoski Paul Wojoski
DWR — 401 & Buffer Permitting Branch DWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
NOTE: 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) which states "At least 30
days prior to submitting a certification request, the project proponent shall request a pre -filing
meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must 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 to this application.
Date of Pre -filing Meeting Request:2 / /8 / (required)
DWR ID # Version (if applicable)
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name• Kenneth W Carothers
Mailing Address: 48373 W Wind Way Norwood NC 28128
Telephone Number: 412-853-6515 Fax Number:
E-mail Address: [e-mail]
D_E
Np m, OAR(N
Depart/WI of Environmental OW;
North Carolina Department of Environmental Quality 1 Division of Water Resources
512 North Salisbury Street 1 1617 Mall Service Center 1 Raleigh, North Carolina 27699-1617
919.707.9000

2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www.saw.usace.armv.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
B. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach 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.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks, impervious surfaces, rip rap, excavation
or dredging below Full Pond/ Normal Water Level elevations, and construction access
corridors. You may use the diagram provided at the end of this application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of
some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: Stanly Nearest Town: Norwood
Lake/ river/ ocean adjacent to property: Tilkery
Property size (acres): 1.5 acres
Subdivision name or site address (include phase/lot number):
48373 W Wind Way Norwood NC 28128
Directions to site - please include road names and numbers, landmarks, etc.: From Norwood
Police de artment — head south on 52 and TL onto Pee Dee at Uwharrie Bank — travel Pee Dee
turns into Indian Mound Road) and TR onto Randalls Church Road. TL onto Randalls Ferry and
TL onto Wind Way
Latitude (in decimal degrees) 32.255830 Longitude (decimal degrees) -80.103890
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Residential -improved
6. Describe proposed work (include discussion as to how hardening of shoreline has been
propose to install Class 11 Rip Rap along shoreline
avoided, or why it is necessary):
FORM: SSGP 09-2020 Page 2 of 6

7. Will work be conducted from land? VI
From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
543 ft @ 6' below full pond
Temporary impacts in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
543 ft. @ 6 ft. above full pond
Temporary impacts (temporary clearing, construction corridor) in square feet:
10. 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): Norman residential manicured
lawn, trees and vegetation
11. Signature
By signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true,
accurate, and complete to the best of my knowledge and belief
• 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
Own /Agent's Signature* [15A NCAC 02H .0502(f)] Date
*Agen 's signature is valid only if an authorization letter from the owner is provided.
12. 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
FORM: SSGP 09-2020 Page 3 of 6

BOOK 1638 PAGE 360(3) 397871
IIII
11111111111111
11
Ell
Filed: 02/16/2018 12:40:45 PM
Suzanne W. Lowder, Register of Deeds
Stanly County, NC
V�J t6,L Nh,"n,r�,
REAL ESTATE EXCISE TAX: $1,600.00
NORTH CAROLINA
GENERAL WARRANTY DEED
CHECKED BY
TAX COLLECTOR:
31 ae
Excise Tax: $ 1,600.00 Recording Time, Book and Page
Tax Map No.
Parcel Identifier No.
Mail after recording to: Grantee: 48373 W. Wind Way, Norwood, NC 28128
This instrument was prepared by: Clegg Mabry, Attorney at Law, Albemarle, NC 28001
THIS DEED made this ‘day of February, 2018, by and between
GRANTOR
LARRYE. LITAKER and wife, LINDA H. LITAKER
48373 W. Wind Way, Norwood, NC 28128
GRANTEt
KENNETH W. CAROTHERS
2337 McIntyre Avenue, Allison Park, PA 15101
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns,
and shall include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all of
their right, title and interest in and to that certain lot or parcel of land and more particularly described as follows:
See Exhibit "A" attached hereto and incorporated herein by reference.
All or a portion of the property hereinabove described was acquired by Grantor by instrument recorded in Book 1411,
Page 98, Stanly County Registry.

BK 1638 PG 361 DOC# 397871
A map showing the above described property is recorded in Plat Book 5, Page 205, and referenced within this
instrument.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging
to the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to
convey the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will
warrant and defend the title against the lawful claims of all persons whomsoever except for the exceptions
hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this
instrument to be signed in its corporate name by its duly authorized officer(s), the day and year first
above written.
.70
Larry er L er
(SEAL) & .•-3 (SEAL)
Linda Litaker
STATE OF NORTH CAROLINA, STANLY COUNTY
I, Clegg Mabry, certify that the following persons personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for the purpose
stated therein and in the capacity indicated: Larry E. L. aker and wit , Linda H. Litaker.
Grantor(s). Witness my hand and official stamp or , jthis the /5 day of February,
2018.
My Commission Expires: August 15, 2019
• I1
Notary Pu
Print Notary Name: Cleg! Mabry,
zS:,
c to o

BK 1638 PG 362 DOC# 397871
EXHIBIT "A"
Being all of Lot 94 as shown on a plat entitled "Section 3 of Lake Side. property of Dr. and Mrs.
E. S. Bivens, Randall's Church, prepared by Glenn K. Margin on June 4, 1966, recorded in Plat
Book 5, Page 205, Stanly County Registry" and more particularly described by metes and
bounds as follows:
BEGINNING at an iron pin in a concrete marker within the right of way of Randall's Ferry Road
(paved). said iron pin having a tie line of South 53-53-45 West 127.75 feet from a concrete
marker where a tree has grown around the concrete marker, and running thence from the
beginning point South 17-01-51 East 293.36 feet to a concrete marker; thence South 26-59-11
West 41.68 feet to a broken concrete marker; thence South 14-10-49 East 219.02 feet to an iron
pipe; thence North 79-29-29 East 85.97 feet to an iron pipe; thence North 06-48-09 West 150.02
feet to a CP&L pipe and cap under shrubbery; thence North 22-39-32 West 90.10 feet to an iron
pipe; thence North 80-04-21 West 47.65 feet to a concrete marker; thence North 16-54-55 West
300.39 feet to a point within the right of way of Randall's Ferry Road; thence within the right of
way of Randall's Ferry Road South 53-53-45 West 22.75 feet to the point of beginning and
containing 0.68 acre, according to a survey by Simpson Surveying for Larry Litaker and wife,
Linda Litaker on May 29, 2012.
Together with the right of owners of Lots 93, 94A, and 95, their heirs, successors and assigns, a
right of ingress, egress and regress over and upon the lands described as follows:
Beginning at an iron pin in a concrete marker within the right of way of Randall's Ferry Road
(paved), said iron pin having a tie line of South 53-53-45 West 127.75 feet from a concrete
marker where a tree has grown around the concrete marker, and running thence from the point of
beginning, South 17-01-51 East 293.36 feet to a concrete marker; thence North 78-16-19 East
20.91 feet to a concrete marker; thence North 16-54-55 West 300.39 feet to a point in Randall's
Ferry Road, said point having a tie line of South 53-53-45 West 105.00 feet; thence South 53-53-
45 West 22.75 feet to the point of beginning.
For reference see Book 1411, Page 98, Stanly County Registry.
This instrument was prepared by Clegg Mabry, Attorney at Law, Albemarle, NC, a licensed
North Carolina attorney. Delinquent taxes, if any, to be paid by the closing attorney to the Stanly
County Tax Collector upon the disbursement of closing proceeds.
The Grantor(s) affirm that the above -described real property DOES DOES NOT
include the primary residence of the Grantor(s).

APPENDIX G
Moderate Rip Rap Stabilization
VEGETATION AND EROSION
CONTROL FABRIC
CLASS 2 RIP RAP
EROSION CONTROL FABRIC
EXISTING GRADE
HIGH WATER ELEV.
TYPICAL CONDITIONS
• 36" TO 72" ERODED CUT
• WAVE EXPOSURE
26

44:
(fr -kg

DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210600
Version*
1
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 3/19/2021
Contact Name * Kevin Thomas
Contact Email Address* [e-mail]
Project Name * Carothers Shoreline
Project Owner* Kenneth W Carothers
Project County* Stanly
Owner Address: Street Address
48373 W Wind Way
Address Line 2
City State / Rovince / Region
Norwood NC
Fbstal / Zip Code Country
28128 USA
Is this a transportation project?* C 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
W 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 and include location information.*
Would like to install class II rip rap around the property. 563 linear
feet of shoreline.
Please give a couple of dates you are available for a meeting.

3/22/2021
3/23/2021
3/24/2021
Please attach the documentation you would like to have the meeting about.
Carothers PCN.pdf
pdf only
3.6MB
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
Submittal Date 3/19/2021