20211526 Ver 1_Shoreline Stabilization_20211022

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:
Jones prefiling.pdf 412.66KB
Pre -fling Meeting or Request Date 5/28/2021
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]
Please provide an email address for payment and requests for more information here.
Owner Information:
Name: * Drew Jones
Email: * [e-mail]
Phone Number: * [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
4811 Hadrian Way
Address Line 2
City
State / Province / Region
Charlotte
NC
Postal / Zip Code
Country
28211
United States

Is there an agent working on the project?* Yes
No
Agent/Consultant Information
...................................................................................................
Name: *
Company Affiliation:
Email: *
Phone Number:
Mailing Address:*
Brittany Hepler
Lake Life Permits
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
123 Institute Street Unit 393
Address Line 2
City
Mooresville
Postal / Zip Code
28115
A signed and dated copy of the Agent Authorization letter:
Jones Auth Agent.pdf 296.89KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Bulkhead Repair/Jones
State / Province / Region
NC
Country
United States
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.*
Upload File
Look up address
Property Address Lookup: *
Latitude: * 35.233913
Street Address
264 Fairway Shores Road
Address Line 2
City
Mt Gilead
Postal / Zip Code
27306
State / Province / Region
NC
Country
US
Longitude: *-80.071830
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*
Jones survey.pdf 527.86KB
diagram Jones.pdf 658.47KB

Please use the diagram at the link below:
https:Hedocs.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.)*
Jones DENR application_l0.pdf 811.94KB
Jones DENR application 9.pdf 1.02MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Norwood
County: * Montgomery
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address: * Fairway Shores, Lot #23, 24, 25
Include phase/lot number
Directions to site: *
From Nowood, take US52 south, LF on NC Hwy 731, LF onto Lillys
Bridge, LF onto Fairway Shores.
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:
Damaged sea wall, bushes and a few trees.
Residential, undeveloped, etc.
6. Property Size 0.58
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
A fallen tree has damaged 20ft of existing bulkhead. Seeking permission
to remove Sea Wall and replace w/ rip rap.
8. How will the work be done?* From Land
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.)
4
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.)
1
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)
a few bushes 8-10 trees

Sketch: diagram Jones.pdf 658.47KB
Jones DENR application_t0.pdf 811.94KB
Jones DENR application_10 (1).pdf 811.94KB
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:* Brittany Hepler
Signature:
Submittal Date: 10/20/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211526 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Chad Turlington:eads\ccturlington
Fayetteville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00