20211311 Ver 1_Shoreline Stabilization_20210902

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.pdf 49KB
Pre -fling Meeting or Request Date 6/25/2021
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 *
Owner Information:
Name:
*
Email:
*
Phone Number:*
Mailing Address:*
Sherri. t.powers @chemours. corn
Rease provide an email address for payment and requests for more information here.
Sherri Powers
Sherri. t.powers @chemours. corn
[phone]
(xxx)xxx-xxxx
Street Address
2312 Rozier Church Road
Address Line 2
city
Lumberton
Fbstal / Zip Code
28360-8887
Name: * Derrick Miles
State / Frovince / Region
NC
Country
US

Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
PO Box 172 492 Pine Oak Drive, Lot 629
Address Line 2
City State / Province / Region
Monroe NC
Fbstal / Zip Code Country
28111 US
Is there an agent working on the r Yes
project?* F No
Project Information [15A NCAC 02H .0502(a) & (b)]
.......................................................................................................................................................................................................................................
Project Name:* Carolina Forest Association Subdivision Boat Slip -Seawall
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
Property Address Lookup:* Street Address
250 Arroyo Drive
Address Line 2
Latitude:* 35.363714
City State / Province / Fbgion
Troy NC
Pbstal / Zip Code Country
27371 US
Longitude:*-80.052750
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*
CFA Seawall-Boatshp Layout.pdf 75.59KB
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.)*
CFA Seawall.pdf 398.54KB
4. Location of the property (where work is to be conducted)

Nearest Town:* Troy, NC
County:* Montgomery
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address:* 250 Arroyo Drive Troy NC 27371
Include phase/lot nunber
Directions to site:*
West on 24/27 toward Albemarle. Turn right on River Road. Go
approximately 5miles to Carolina Forest Subdivision entrance on left at
Gatehouse
Rease include road narres and nunbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Site is being used for same purpose. This is a replacement in kind project
other than removing existing wooden seawall and upgrading to
boulder/riprap
Residential, undeveloped, etc.
6. Pro pertySize 1.14
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Shoreline will be removal of existing wooden perimeter and replace with
riprap/boulders
8. How will the work be done? * I7 From Land
V 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.)
1890
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward: *
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
2520
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)
Only disturbance would be already established grass area enough to slope
for rip rap/stone vs. original wood wall.
Sketch: CFA Boat Shps-Sea Wall Diagram.pdf 114.44KB
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $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:* Sherri Powers
Signature:
JW pvQ
Submittal Date: 8/30/2021

Initial Review
Is this accepted into the review
process?*
Project Number:* 20211311
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

A
u
fib
4

Contact Name* Sherri Powers
Contact Email Address* [e-mail]
Project Owner* Sherri Powers
Project Name* Carolina Forest Association Subdivision
Project County* Montgomery
Owner Address:* Street Address
2205 River Road
Address Line 2
aty State / Province / Pegion
Troy NC
Postal / Zip axle Country
27371 Montgomery
Is this a transportation project?* C Yes c: No
Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - F- 401 Water Quality Certification -
Regular Express
F- Individual Permit F- Modification
F- Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes c: 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.*
Carolina Forest Association Subdivision is requesting to replace
existing sea wall with rip rap/boulders. Replacement in kind of boat
slips is also being required. There is approximately 200 linear meter
of shoreline on Lake Tillery that we need to replace the existing
seawall due to meeting useful life of almost 25-30yrs.
This is located at 2205 River Road Troy NC 27371. Boat Slip area is
at Clubhouse which has a physical address of
250 Arroyo Drive Troy NC 27371.
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.
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.
Signature *
Submittal Date 6/25/2021

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