20230514 Ver 1_Shoreline Stabilization_20230417

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 4/3/2023
submitted on: *
Owner Information:
........ ........ ........
Name: * Timothy Webster
Email: *
Phone Number:
Mailing Address: *
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
2986 Kamerin Street
Address Line 2
City
Randleman
Postal / Zip Code
27317
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
...............................................................................................................................................................................
Name: * Rick Trone
Company Affiliation:
Email: *
WithersRavenel
[e-mail]
State / Province / Region
NC
Country
USA

Phone Number:*
[phone]
(XXX)XXX-xxxx
Mailing Address: *
Street Address
115 MacKenan Drive
Address Line 2
City
Cary
Postal / Zip Code
27511
A signed and dated copy of the Agent Authorization letter:
SIGNED Agent Authorization Webster.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * 638 Deerfield Road Shoreline Stabilization
State / Province / Region
North Carolina
Country
United States
61.27KB
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
Upload Map:
Latitude: * 35.271081
Longitude:* -80.088950
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*
Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/O/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.)
4. Location of the property (where work is to be conducted)
Nearest Town: * Mt. Gilead
County: * Montgomery

Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address: * 638 Deerfield Road, Mt. Gilead, NC 27306
Include phase/lot number
Directions to site:*
From Mt. Gilead, take NC-73 W for 6.9 miles. Turn left onto Lillys Bridge Road for 1.2 miles. Turn right on Deerfield Road for
0.6 miles. Turn left to stay on Deerfield Road. Continue straight to stay on Deerfield Road, the destination will be on the left in 0.1
miles.
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..
Existing land use consists of a lake -front residential home, wooden bulkhead/walkway, and wooden sidewalk with stairs leading to
a boat house.
Residential, undeveloped, etc.
6. Property Size 0.54
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Proposed work includes removal of the existing wooden bulkhead, laying back the slopes and replacing the existing wooden
bulkhead with boulders. The existing bulkhead is in need of repair and shoreline erosion is occurring behind and above the
bulkhead. Erosion is potentially undermining the stability of some trees located onsite. A portion of the shoreline currently consists
of boulders and the intent is to remove the existing and ineffective wooden bulkhead with boulders similar to the opposite side of
the boathouse. The contractor intends to access the work site from land without the need for any vegetation removal or
disturbance.
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.)
0
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.)
4,960
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)
The lot is sparsely vegetated with vegetation consisting of scattered hardwood trees. There is no shrub or herbaceous layer from
the shoreline and landward 50'. A dozen or few trees are present from the normal lake level and landward 50'.
Sketch: 50 ft Impact Area Exhibit.pdf 232.76KB
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):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
d $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:

d I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
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.
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');
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');
d 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:* Rick Trone
Signature:
AW TAW
Submittal Date: 4/3/2023

Initial Review
Is this accepted into the review process?* Yes O No
Project Number: * 20230514 Version:*
Select Reviewer: *
Select Reviewing Office
Has payment been received?*
What amount is owed?*
Chad Turlington:[e-mail]
Fayetteville Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification
$240.00
$570.00