20211312 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:
Summerhouse Lot 35-PreFiling.pdf 145.85KB
Pre -fling Meeting or Request Date 7/13/2021
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 payrrent and requests for pure information here.
Owner Information:
Name: * Michael Culbertson
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
478 Atwood Drive
Address Line 2
City
State / Frovince / Region
Clayton
NC
Fbstal / Zip Code
Country
27520
US

Is there an agent working on the f Yes
project?* r No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Summerhouse Pt Lot 35
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: Summerhouse Lot 35-Vcinity.pdf 277.02KB
Summerhouse Lot 35-Site Map.pdf 240.32KB
Latitude:* 35.274310 Longitude:*-80.098400
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*
Summerhouse Lot 35-SiteDrawing.pdf 300.43KB
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.)*
Summerhouse Lot 35-Shoreline.pdf 315KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Norwood
County:* Stanly
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address:* 246 Summerhouse Pt -.Lot 35-Edgewater
Include phase/lot nunber
Directions to site:*
See attached map
Aease include road narres and nunbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
No existing structures. New Lot 35 in Edgewater subdivision.
I3sidential, undeveloped, etc.
6. Property Size .913
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Build new 800 sq ft Dock and install 137' rip rap 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, backfill, excavation, rip rap, retaining walls, etc.)
274
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.)
411
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 photo
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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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:
Submittal Date: 8/31/2021

Initial Review
Is this accepted into the review
process?*
Project Number:* 20211312
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 fame .}ell Page
Contact Email Address* [e-mail]
Project Owner* Michael Culbertson
Project Name* Summerhouse Point Lot 95
Project County* Stanly
478 Atwood Drive
clavton NC
r„i . .
27520 USA
is this a transportation project?* Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular 401 Water Quality Certification - Express
Individual Permit Modification
Shoreline Stabilization
Does this project have an existing project ID#?
Yes No
Do you know the name of the staff member you would like to request a meeting with?
Chad T ui iingtGr,
Please give a brief project description below and include location information.*
The owner wants to install 151 ft- Riprap Shoreline and 800 Sq Ft Boat Dock
ov stjgnlnD bOn- 1 r<,.tifi, that 1 wave renti .3nrr _,nae.stnnrl }►1l} per the Fednr:Il r_tpan Water Alt Sncticmn
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 inderstand by signing this form that I rannnt submit my Rnpliraiinn until ?tr} r_.Ap.ndar drays alter 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 dock has expired. and you
can submit an application.
Signature*
ieff Tull
Submittal Date 7/1312021

K, State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 1SA NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
LNVM0MMF,HI nL ounLii r FORM: SSGP 02-2017
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
Lake
(At Full Pond/ Normal Water Level)
Full Pond/ Normal Wate Level
Shoreline
Plan View
FORM: SSG 02-2017 Page 1 of 3

Full Pond/ Normal Water
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Existing Dock
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I
EXAMPLE
Plan View
FORM: SSGP 02-2017
Page 2 of 3

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NOTES:
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1310 Brief Road East Monroe, NC 28110
QUALITY IS OUR PRIORITY
PH: (T04) T83-60W E-M/WL: davidfttl,..eyiq.n" FAX [phone]
DRAWING NAME:
SUMMERHOUSE POINT
SCALE: 1- . SO.
SURVEYED BY; TC/Ls
DRAWN BY: DEG
CHECKED BY: DEC
SURVEY
DATE: 06/02/21