20210904 Ver 1_Shoreline Stabilization_20210616

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water QualityCertification, 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:
Cohen DWR Pre -Filing Meeting Request
50.67KB
Form.pdf
Pre -fling Meeting or Request Date 5/5/2021
ID# 20210904
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.
Robert A Cohen
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
224 Clearwater Court
Address Line 2
City
Norwood
Fbstal / Zip Code
28128
State / Rovince / Region
NC
Country
USA

Is there an agent working on the
project?*
r Yes
C: No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Cohen Residence 50
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: DWQ Cohen 50 4.pdf 142.25KB
Latitude:* 35.276770
Longitude:* -80.098540
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*
Cohen Residence 2.22.2021 (1).pdf.pdf 321.21KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/O/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.)*
lot 50 pic 1.pdf 4.01 MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Norwood
County:* Stanly
Lake/ river/ ocean adjacent to Tillery
prope rty:
Subdivisions name or site address: * 224 Clearwater Court Norwood NC 28128
hclude phase/lot number
Directions to site:*
From the police department in Norwood - head south on 52 and turn left
onto Pee Dee Avenue (turns into Indian Mound Road) Travel
approximately 4 miles and turn right onto Randalls Church Road. Turn
left onto Edgewater Drive & Clearwater Court is 3rd road on the right.
Rease include road narres and nurrbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
residential development, lot under development
Residential, undeveloped, etc.
6. Property Size .705
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Build a new pier, boathouse and 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.)
136 ft @ 6' below
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.)
136 ft. @ 1' above
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nurrber of trees, for instance)
normal residental
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:
• 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:* Robert A Cohen
Signature:

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210904
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

Page 4of4

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NORWOOD, NORTH CAROLINA
DATE: FEBRUARY 2021
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DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210904
Version*
1
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 5/5/2021
Contact Name * Robert A Cohen
Contact Email Address* [e-mail]
Project Name* Cohen Residence 50
Project Owner* Robert Cohen
Project County* Stanly
Owner Address: Street Address
121 N Main Street
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?
no
Please give a brief project description below and include location information.*
Build a new pier, boathouse and install class II Rip Rap
Edgewater on Lake Tillery Subdivision
224 Clearwater Court
Norwood NC 28128
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
,OgeuGt&
Submittal Date 5/5/2021

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