20221149 Ver 1_Shoreline Stabilization_20220825

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Quality
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
Submission Form
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.
Pre -Filing Meeting Date Request was 8/2/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Jason King
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
627 Birdie Lane
Address Line 2
City
Norwood
Postal / Zip Code
28128-9409
State / Province / Region
NC
Country
US
Is there an agent working on the project?* Yes
No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * King Bridie Ln
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:*
35.222445
Street Address
627 Birdie Lane
Address Line 2
City State / Province / Region
Norwood NC
Postal / Zip Code Country
28128-9409 US
Longitude: *-80.099518
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*
Survey.pdf 402.2KB
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.)
Shoreline pic 1.pdf 20.42MB
Retaining wall pics.pdf 110.45KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Norwood NC 28128
County:* Stanly
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address:*
627 Bridie Ln, Lots 21/22 of Acorn Acres
Include phase/lot number
Directions to site: *
Hwy 52 south to Fork Rd. turn left. Turn left onto Acorn Acres Rd. Turn
right onto Bridie Ln. Home is at the end of Birdie Ln
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: *
Residential home on Lake Tillery.
Residential, undeveloped, etc.
6. Property Size
0.34
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Remove fallen wood retaining wall and replace it with new wooden
retaining wall and attach it to the existing wall.

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: *
0
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
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.)
30 yards
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)
No trees are in the are of the shoreline. Small patch of weeds in the
lakebed.
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):
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:
a I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
a 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.
a 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");
a 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");
a I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
a I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:
Robert Brian Beachum
Submittal Date: 8/23/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221149 Version:* 1
Select Reviewer: * Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* ( No Payment Needed
C Fee Received
C• Need Fee - send electronic notification
What amount is owed?*
C• $240.00
C $570.00

— — N68° 33' 30"E
10.94' tie line
Patricia Chewning Molica
Lot 23 Map Book 5, Page 33
Block A
EIP- CONTROL CORNER
N: 537582.26'
E: 1671542.94'
NAD 83 (2011)
Stephen M. Whitley & wife
Christina M. Whitley
Deed Book 361, Page 112
Lot 16 & Part 17, Map
Book 5, Page 33 Block A
emn located at or about
the centerline intersection
of Acorn Acres Road
& Birdie Lane S51°45'26"W
247.86' tie line(not to scale)
TILLERY IMPOUNDMENT
(LAKE TILLERY)
S55° 48' 33"W _ — — —
19.68� — — —
N33° 41' 13"W
14.47' tie line
William L. Snow
Deed Book 1626, Page 742
Lot 17 & Part 18, Map
Book 5, Page 33 Block A
William F. Muto & wife
Linda K. Muto
Deed Book 667, Page 73
William F. Muto & wife
Linda K. Muto
Deed Book 667, Page 73
CERTIFICATION OF OWNERSHIP
I (we) hereby certify that I am (we are) the owner(s)
of the property shown hereon, which property is
within the subdivision regulation jurisdiction of
Stanly County, and I (we) freely adopt the plan
of recombination.
Digital Signature and seal
not for recording conveyance
or sales. Copies with original
signtaure and seal will be
provided. This is for email
purposes only.
epk - existing pk nail found
eis - existing iron stake found
ecm - existing concrete marker found
errs - existing railroad spike found
eia - existing iron axle found
smn - set mag nail
emn - existing mag nail found
sip - set iron pipe
eip - existing iron pipe found
sir - set iron rod
eir - existing iron rod found
cp - calculated point (no stake set)
right of way line plotted
surveyed line
line plotted (not surveyed)
tie line surveyed
utility line plotted
easement line plotted
ditch line plotted
RECOMBINATION SURVEY FOR
Jason King
East Center Township
Stanly County North Carolina
October 5, 2020 Scale 1" = 20'
Title Reference: Deed Book 1211, Page 66
Powers Surveying
Firm License: F-1359
John D. Powers, Jr., PLS L-3719
750 South Roberts Avenue
Lumberton, North Carolina 28358
[phone]
NORTH CAROLINA
ROBESON COUNTY
I, JOHN D. POWERS, JR., PLS L-3719, CERTIFY THAT
THIS MAP WAS DRAWN UNDER MY SUPERVISION
FROM AN ACTUAL SURVEY MADE UNDER MY
SUPERVISION, DEED AND DESCRIPTION RECORDED
IN DEED BOOK 1211, PAGE 66, THAT THE RATIO OF
PRECISION AS CALCULATED BY LATITUDE AND
DEPARTURES IS 1/10,000'+; THAT THE BOUNDARIES
NOT SURVEYED ARE SHOWN AS BROKEN LINES
PLOTTED FROM INFORMATION FOUND IN BOOKS
REFERENCED, THAT THIS MAP WAS PREPARED IN
ACCORDANCE WITH G.S. 47-30 AS AMENDED
WITNESS MY HAND AND SEAL THIS 16TH DAY OF
OCTOBER, A.D., 2020
THIS PLAT IS THAT OF A SURVEY OF ANOTHER
CATEGORY, SUCH AS THE RECOMBINATION OF
EXISTING PARCELS, A COURT ORDERED SURVEY
OR OTHER EXEMPTION OR EXCEPTION TO THE
TO THE DEFINITION OF SUBDIVISION.
STATE OF NORTH CAROLINA
COUNTY OF STANLY
REVIEW OFFICER OF STANLY COUNTY
CERTIFY THAT THE MAP OR PLAT TO WHICH
THIS CERTIFICATION IS AFFIXED MEETS ALL
STATUTORY REQUIREMENTS FOR RECORDING.
REVIEW OFFICER
DATE
GRAPHIC SCALE
0 20 30 40
( IN FEET )
1 inch = 20 ft.
DRAWING #: 20-449.DWG
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