20211186 Ver 1_Shoreline Stabilization_20210802

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:
PreFillingRequest.pdf 118.32KB
Pre -fling Meeting or Request Date 6/4/2021
ID# Version
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 payment and requests for pure information here.
Owner Information:
Name: * Susan Martell
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
8 Spring Hope Ct.
Address Line 2
City
State / Frovince / Region
Jamestown
NC
Fbstal / Zip Code
Country
27282
United States

Is there an agent working on the f Yes
project?* r No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Lot 29 Talon Court
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 Lookup address
Upload Map: VicinityMap.pdf
Latitude:* 35.265980
321.95KB
Longitude:*-80.099410
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*
SitePlan.pdf 331.59KB
BRN3C2AF4E6BFD3_000308.pdf 148.86KB
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.)*
Photo.pdf 418.89KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Nowood
County:* Stanly
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address:* Eagle Point
Include phase/lot nun ber
Directions to site:*
NC 24/27 to Indian Mound Road. Left on Randalls Ferry Road, Left onto
Talon Court.
Rease include road narres and nunters, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
No existing Structures. New Vacant Lot #29 Eagle Point Subdivision
Residential, undeveloped, etc.
6. Property Size .58
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Install 140' New Rip -rap shoreline and build new 1200 sq ft Boat Dock
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.)
140'x2'=280 sq ft
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 w alls, etc.)
140'x3'=420 sq ft
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)
See attached picture
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");
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:* Jeff Page
Signature:
X )1R1G

Initial Review
Is this accepted into the review
process?*
Project Number:* 20211186
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

DWR Pre -Filing Meeting Request Form
Contact Name*
Jeff Page
Contact Email Address*
Jeff. [e-mail]
Project Owner*
Susan Martell
Project Name*
Lot 29 Talon Ct
Project County*
Stanly
Owner Address: *
Street AddreF-
8 Spring Hope Court
Address Line 2
City
Jamestown
Postal / Zip Code
27282
Is this a transportation project?*
(-) Yes QQ No
Type(s) of approval sought from the DWR:
L 401 Water Quality Certification - Regular
❑ Individual Permit
Q Shoreline Stabilization
Does this project have an existing project ID#?*
Yes No
fTA'Jf�
1:
NORTH CAROLINA
Envlronm¢nec! Q�alily
State / Province / Region
NC
Country
USA
401 Water Quality Certification - Express
Modification
Do you know the name of the staff member you would like to request a meeting with?
Chad Turlington
Please give a brief project description below and include location information.*
Owner wants to install 111 feet of rip rap shoreline and 1200 Sq ft boat dock.
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.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.

1 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*
Xf.I G
Submittal Date 6/4/2021

3 ft below full pond water level 4 ft- above full pond water level 2 ft. additional clearing
'if necessary
Existing bank
10 ft, bank
Side Vi
AMPLE
FORM: 5, UP oz-2017
Page z of 2

,_'; 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
LNVIROW— NtAL OU AI. - FORM: SSGP 02-2017
Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
h. I nratinn of rin ran OF fill to ho niarerl ahnva the FlitI Pnnrl/ NormnI Wntar I Pvwl Plavation
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
Full Pond/ Normal Water Level
Shoreline
Plan View
Full Pond/ Normal Water
Lake
(At Full Pond/ Normal Water Level)
wrzg ��
Lake
JA r,dl ao*Iel Pk —I water f-11 Existing Dock
3"150 it
Be DW ha pond w
4 ft. 150 ft
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adrfiti l del+ine u
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FORM: SSGP 02-2017
E XA P L E
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