20240198 Ver 1_Shoreline Stabilization_20240201

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*
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
[e-mail]
Please provide an email address for payment and requests for more information here.
Teresa Austin
teresa.austinl [e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
648 Fairway Shores Road
Address Line 2
City
Mt Gilead
Postal / Zip Code
27306-9189
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Yvette Huffinan
Lake Permit Services, LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
US

Mailing Address: *
Street Address
PO Box 6369
Address Line 2
City
Hickory
Postal / Zip Code
28603
A signed and dated copy of the Agent Authorization letter:
Austin Teresa - 1 Signed Agent Auth.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Austin - Mt Gilead
State / Province / Region
NC
Country
United States
510.67KB
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: * 35.229278
Street Address
648 Fairway Shores Road
Address Line 2
City
Mt Gilead
Postal / Zip Code
27306-9189
State / Province / Region
NC
Country
US
Longitude: *-80.065869
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 *
of
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.)
Pic
mi
Pic
4. Location of the property (where work is to be conducted)
Nearest Town: * Mt Gilead
County: * Montgomery
Lake/ river/ ocean adjacent to Tillery
property:
Subdivisions name or site address: * Fairway Shores Dev, Lot # 29
Include phase/lot number
Directions to site:*
From Charlotte, take US-74 E.Then 3.9 miles. Take left ramp toward NC-27 E/Albemarle Rd. Go for 0.4 mi.
Continue on Albemarle Rd (NC-27 E). Go for 37.6 mi. Turn right onto E Main St (NC-24/NC-27/NC-73). Go for 6.2 mi. Turn
right onto NC Highway 73 W (NC-73). Go for 3.5 mi. Turn right onto NC-1112. Go for 1.5 mi.
Turn right onto Fairview Farm Rd. Go for 1.5 mi. Turn left onto Lillys Bridge Rd. Go for 0.6 mi. Turn right onto Fairway Shores
Rd. Go for 472 ft. Turn left onto Fairway Shrs. Go for 0.3 mi to destination.
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, Developed.
Residential, undeveloped, etc.
6. Property Size .28
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Repair of shoreline stabilization to prevent further erosion.
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.)
130
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.)
130 and 300 temporary corridor
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)
Grassy yard with 2 trees.
Sketch: Austin Teresa - 1 Signed Application.pdf 694.7KB
Austin Teresa - 1 Survey.pdf 563.56KB
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 $323.00 for impacts to lake (below normal water level) of less than 1 acre
0 $767.00 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:* Yvette Huffman
Signature:
Submittal Date: 1/28/2024

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20240198 Version: *
Select Reviewer: *
Select Reviewing Office
Has payment been received?*
What amount is owed?*
Chad Turlington:chad.turiington
Fayetteville Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification
$240.00 $570.00
$323.00
$767.00