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State of North Carolina
Department of Environment and Natural Resources
1_iD
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL GUALITY 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
covero-ci 000:�_
Lake 3aFt x LIL)4
(At Full Pond/ Normal Water Level)`
Fuil Pond/ Normal Water Level
IMP _ r ! li [
Shoreline
Plan View
Lake
l►r c„u f W NOMW Y1Yt f fepell Existing Dock
/30hs7h
3h[150fr
r _ &'IWr full PmW NWL
Full Pond/ Normal Water Level
�hare�ne _¢ ih.l50h
RipraP - AbImfWl P"w NWL
7 h.F 150'c—
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FORM: SSGP 02-2017 EXAMPLE Page 1 of 3
Plan View

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Side View
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3 ft, below full pond water level 4 ft. above full pond water level ft• addl'If neecesscess clearing
ary
Existing bank
10 ft. bank
Side Vielw .-.,C-y
AMPLE
FORM: SSGP 02-2017 Page 2 of 2

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tD#* 20201921
Version* 1
Regional Office* Fayetteville Regional Office - [phone]
Reviewer List* Chad Turlington
Pre -Filing Meeting Request submitted 12/9/2020
Contact Name *
Contact Email Address*
Project Name *
Project Owner*
Project County`
Owner Address:
Brian Beachum
[e-mail]
257 Landing Trail
Hux Investments LLC
Montgomery
Street Address
257 Landing Trail
Address Line 2
Lot 19
oty
Mount Gilead
Postal I Zip Cade
27306
Is this a transportation project?* f Yes f: No
Type(s) of approval sought from the DWR:
r 401 Water Quality Certification - F_ 401 Water Quality Certification -
Regular Express
f Individual Permit F_ Modification
9 Shoreline Stabilization
Does this project have an existing project ID#?*
n Yes r: No
State + Rawnre r fegron
NC
Country
Montgomery
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below. *
Shoreline Stabilization on Lake Tillery for newconslruction of home
and dock.
Please give a Couple of dates you are available for a meeting.

12121 /2020
12/28/2020
12/3012020
1 l4/2021
1/512021
Please attach the documentation you would like to have the meeting about.
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 farm 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.
• 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
_ i� tt aS'tcir s rrnir w
Submittal Date 121912020

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