20220718 Ver 1_Shoreline Stabilization_20220525

r a,
ROY COOPER p � �':
Go rnor t
le s
MICHAEL S.REGAN 4`"'a },."u
Secretary !4,41t00
S.DANIEL SMITH NORTH CAROLiNA State of North Carolina
Orr-odor Environmental Quality
Department of Environment Quality
Division of Water Resources
15A NCAC 02H.0500—Water Quality Certification, Shoreline Stabilization
FORM: SSGP 09-2020
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS,FedEx, etc.)
Paul Wojoski Paul Wojoski
DWR -401 & Buffer Permitting Branch DWR -401 & Buffer Permitting Branch
1617 Mail Service Center 512 N.Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604
NOTE: 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) which states "At least 30
days prior to submitting a certification request,the project proponent shall request a pre-filing
meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5),all
certification requests must 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 to this application.
Date of Pre-filing Meeting Request: / / (required) RECEIVED
DWR ID# Version (if applicable) MAY 2 5 2022
DEO-WATER RESOURCES
401 &BUFFER PERMITTING
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: \\ r(r,nc, T SirnpaorN a.
Mailing Address: PO I 1
O\'I Nkt)N ► \C a g 3 aci
Telephone Number: r;\eu1 \C\c -,Qy71 Fax Number:
E-mail Address: 6)rcr o\r‘Q1\GC1d COOfILAN0D . m
DE -4
North m Envm Quality R
St2 NorthCarolina SalisburyDepart Streetent!of 1617 Mailiron Serviceental Center RaleigDivisionh.!NoforthWater Carolina
esources 27699-Ill?

2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www.saw.usace.army.mil/Portals/59/dots/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
B. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach 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.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks, impervious surfaces, rip rap, excavation
or dredging below Full Pond/Normal Water Level elevations, and construction access
corridors. You may use the diagram provided at the end of this application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of
some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: &\f-01A w Nearest Town: N),Rvj OC)
Lake/ river/ocean adjacent to property: l i1\erl
Property size (acres): trQA Q,[v Q Subdivision name or site address (include phase/lot number):
Directions to site -please include road names and numbers, landmarks, etc.: i7jrr 4
cIt\a; l ►X,IN -A V , . 1� 4i Rerr d\ -It I ( 3 1-ish5►tlre.s rel.
Latitude (in decimal degrees)3 .a30 733) Longitude (decimal degrees)- Q.I O -1 1.0-7
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped,etc.): VN/21241P4i-C-131
6. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): Qui\AVNJ(�e.,a �)ecf 1�LJ.1 arv.U1 Sect dad -
WOOok 50/zWQ.20 t4Jkl . R► PiAe
FORM:SSGP 09-2020 Page 2 of 6

7. Will work be conducted from land? EY From water?
8. Total amount of impacts below the normal pool lake level/ Normal Water Level
P anent impacts (includin all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
\a,h Rip 9 ICE.00 -
Temporary impacts in square feet:
NSA
9. Total amount of impacts above the normal pool lake level/Normal Water Level and 50 feet
land-ward N1A
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction corridor) in square feet:
10. 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): y.A.//6 1 /
11. Signature
By signing below,I, as the project proponent,certify to the following:
• The project proponent hereby certifies that all information contained herein is true,
accurate, and complete to the best of my knowledge and belief
• The project proponent hereby requests thatthe certifying authority review and take action
on this CWA 401 certification request within the applicable reasonable period of time
1 t �
e gent's Signature* [15A NCAC O2H .O5O2(f)] Da e
*Agent's signature is valid only if an authorization Ietterfrom the owner is provided.
12. 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
FORM:SSGP 09-2020 Page 3 of 6

Lake
(At Full Pond/Normal Water Level)
il -I
e i(1$3 Y -
lorj/
0)0441
..-
---- -----N----- - --. ._------: 3,-(coAl"
Full Pond/ Normal Water Leve u---\--------------------------
Shoreline --------,---.._.--"N._--------- ' (Leek„Z
00.P.-ire..•01
j- z 4c.-1- lay 00 4e,"--- Cl-e''' 7 i' Iv", '5‘ay--- 4611356frf
Plan View
Lake
(At Full Pond/Normal Water Level) Existing Dock
30ftx7ft
0 in, olio ;., , , 3iftx150ft
trveditt 111•.-..e.e • 4.S
.„, Below full pond/NWL
Ref Pond/Normal Water Level.0'..."101,01-64.41,10,704014' iNSIlik.
®"ntriiretnr''"''''' ro.Z4Ve;.trii: 4 4 to ka:2
......t.., irre Above full pond/NWL
2 fL x 150 ft. ..... WIMPIPTIV.41' , 000
addrtional clearing
•it necessary
i
. ,
leWitii V/ , it, 4, ti i ) g.. Imal^A
Avo, 1 - . , . A i • „
th pato 11 . . .
Eon I %0 ,i ' ^ 4.ANO LIAM
Plan View
FORM:SSGP 09-2020 Page 4 of 6

, ,
, .
2 c ,,,y , 6.1/7)-vi
w
,...____4
4g —a-) ‘-1. 344-- t(iiivti-12--
u Lake ,.n
(At Full Pend/Norma!Wat- Le ,-,j
c
1S
a-C-) 13:el ate'
mxnnvm in .e Y�ieMYa J1m,We'm •
Side View a
FORM:SSGP 09-2020 Page 5 of 6

f LAKEV-�SITE -
LEGEND LAKE TILLERY TIE LINE DATA TILLERY
LINE BEARING DISTANCE z
R/W RIGHT OF WAY I= LI N 25'05'53" E 3 37'
Q CENTER LINE cE
0 L2 N 09'44'03" W 4 95'
Z L3 N 01'27'51" E 6 37'
PIER &
BOAT
REFERENCE HOUSE10111°114114
-k FOUND 1 5" IRON
DEED BOOK 1528, PAGE 815 PIPE 1 3' ABOVE
. PLAT BOOK 1, PAGE 218 0
BOTTOM OF LAKE �Nr"
SET 5/8" REBAR (UNDER WATER WHEN VICINITY MAP (NOT TO SCALE)
WALL 0.5' ABOVE SURFACE LAKE IS FULL)
\v
AT EDGE OF SHORE W
U S SO'17 24 STATE OF NORTH CAROLINA
Z �� 38 00' I. BARRETT D EATMAN, PLS L-3556, CERTIFY THAT THIS
DUKE ENERGY C g0•�''2Q" SURVEY MADE UNDER PLAT WAS DRAWN NDER NY SUPERNSION FROM A MY SUPERVISION(REFERENCES ASASS A
SHOWN
WALL �,. FOUND LEANING HEREON); EXCEPT AS SPECIFICALLY STATED OR SHOWN ON
SET 5/8" REBAR 110,QQ' 31P�,�. 1" IRON ROD 1' THIS PLAT,THIS SURVEY DOES NOT PURPORT TO REFLECT ANY
ABOVE SURFACE OF THE FOLLOWING WHICH MAY BE APPLICABLE TO THE
0 5' ABOVE C�- WALL SUBJECT REAL ESTATE. EASEMENTS,OTHER THAN POSSIBLE
SURFACE 1.111V ` EASEMENTS THAT WERE VISIBLE AT THE TIME OF MAKING THIS
\1 GRADY V. SHUE SURVEY, BUILDING SETBACK LINES, RESTRICTIVE COVENANTS,
�, DECK 1 WALL SUBDIVISION RESTRICTIONS; ZONING OR OTHER LAND USE
"III"IIand wife REGULATIONS, ANY OTHER FACTS THAT AN ACCURATE AND
BEVERLY A. SHUE CURRENT TITLE SEARCH MAY DISCLOSE DECLARATION IS MADE
N 80 17'24' E DECK iir .°°'''°'-'....".''''''''"),'
DB 561, P 394 TO ORIGINAL CURRENT ABLE TO ADDITIONAL INSTITUTIONPURCHASER OF THE S ANO IS NOT
329 g7' PORCH ORY SUBSEQUENT
(.0 OOWNERS 2 IS MY ORl20 19L SIGNATURE.THIS DAY
a�O
FOUND 1 5" IRON o TILLERY BEACH ,� r-
PIPE WITH PLASTIC HOUSEI -A --la FOURTH ADDITION ��-1f' '
CAP 01' ABOVE Z. g �~
ASPHALT PORCH O O( ; PB 1, P 218 BARRETT D.`EATMAN,'RLS L-3556 ,
SURFACE 2 1 -1 - ,
WILLIAM M. O'NEAL O Ls; CA \ �� 'r n
and wife o,W o 6.—�a 686 ,
ELIZABETH R 651 .+ (- o_DB 355, P 651tBUILDINGI _ ,e7'C )
. , -
689 it
688 \
SET 5/8" REBAR
ASPHALT 0.5' ABOVE %,
i WALL . SURFACE FJ
O
0.------POI WALL ©COPYRIGHT 2019 BY BARRETT D. EATMAN
SET 5/8" REBAR , 02.00'p1 ,N PLS. ANY ALTERATIONS OR COPYING OF THIS
0 3' ABOVE 0
MAP WITHOUT PRIOR WRITTEN CONSENT IS A
SURFACE ,�,�, �' W ! FOUND 1.5" IRON COPYRIGHT VIOLATION. ORIGINAL SIGNED AND
FOUND 1" IRON E f 'r S 84°26'3 i PIPE 01' ABOVE SEALED WITH RED INK.
PIPE 0 2' ABOVE N 83.04'15' POINT IN WALL .(^'
SURFACE SURFACE BOUNDARY SURVEY FOR
101 87'
FOUND 1/2" IRON �- - ---
S ROD 1' ABOVE -
SURFACE _ ROAD
- TELFAIR SIMPSON
014 MILER 1755 — —_ — __�
(BERRY HILL DRIVE)— ,��- RO /1 D CENTER TOWNSHIP
— — '— HIGHSHORES n STANLY COUNTY, N.C.
— — 50' R/W — � SCALE: 1"= 30'
R/W MAY 6, 2019
— 30' 0 30' FILE # 181002
� p�
' _ �� IINIYI91t991i��'� MII'11I1I II BARRETT D EATMAN PLS L-3556
— — �� 0. 22 ACRE 11111�11;11'1111111111 vl 1',.,4' ^J1,,tir 1NAt#&II 25152 CABIN RIDGE ROAD
—
ALBEMARLE, NC 28001
— �— CALCULATED BY COORDINATES 1"= 30' 704-983-2451

ConnectGlS Feature Report
https://stan ly.connectgis.com/DownloadFile. ashx?i=_ags_mapebd6f9...
Stanly
Printed March 09, 2022
See Below for Disclaimer
Rail Roads
Roads
l arcels
Lease Land Records
•
Surrc Lfnding Counties
This map is prepared for the inventory of Real Property found within this jurisdiction, and is compiled from recorded deeds, plats and other public records and data.
Users of the map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained
on this map. The Stanly County Geographic Information Systems Division of the Office of Information Technology assumes no legal responsibility for the information
contained on this map. Also, when the deeds and or plats are viewed for a parcel, the Stanly County Register of Deeds Office makes no guarantees regarding the
collection, accuracy, authenticity, or use of these records. The web site is for informational use and convenience only. The Register of Deeds shall in no way be held
responsible for errors or omissions in these records nor for any actions resulting from their use. The official records are kept in the Stanly County Register of Deeds
Office. To view deeds on this site you must install the AlternaTlFF viewer. To install, please visit http://www.alternatiff.com/install-ie/ Warning: City of Norwood:
Within the city limits of Norwood any improvements such as boathouses or piers that have been built on land owned by Duke Energy are considered to be located
on leased land and therefore will not be found using this program. These improvements are also not considered to be located within the city limits of Norwood and
are taxed accordingly. These leased land records can be identified by going to StanlyTax.com. If a property is located on Lake Tillery in Norwood has a parcel number
of 1234 then the tax bill for the waterfront improvements located on Duke Energy property could be found by placing an LL01 after the parcel number. On
StanlyTax.com search by Parcel / Record number and enter 1234LL01 for this example.
1 of 1
3/9/2022, 2:44 PM

a+.
` lg9
0
at ��
cr
i Q
Y# R *s { '
r',
bt? P N , i.,; , 1 ; ...,,..7 7.;_;,::( .."Arv'''.lailirit'.,,0 w,4:,...w.::,,,i i''

f
`� , rr 1 I ,.
4 �$€ " + t
t.
1
� ' t
a
-,'::;'':'':7---:::... '--..'''.*..,,,..11,';'''':g1:.":-::7;7: -''' - 71 '1.‘1:. : .—1-1 I'.t:*a'''s:i----;'''''L' '-'-------' \ '
T_
i'
——::
1 T i
B

1111
- _ ,
.-•
•
-•
'PITA. ,g1,4",5-4
4. .1...
'
•
,
. .
-‘1‘' * • • ,
•
„4-ekti
• °
( / . •
• 1..1.