20171311 Ver 1_Shoreline Stabilization_20171016

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIRONMENTAL. QUAL. TY FORM: SSGP 02-2017
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.)
Karen Higgins Karen Higgins
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 D r= :y
I
A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information 1 93 2017
Name: HenryJ. and Mary E. Persia
Mailing Address: 5015 Harness Ln ao1 & BUFFER PERM T
Colfax, NC 27235
Telephone Number: 336-763-4190 Fax Number: 336-763-4152
E-mail Address: [e-mail]
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.miI/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf)
Name: TBD
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
B. Project Information [15A NCAC 02H .0502(a) & (b
Fax Number:
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.
FORM: SSGP 02-2017 Page 1A

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: Montgomery Nearest Town: Mt. Gilead
Lake/ river/ ocean adjacent to property: Lake Tillery
Property size (acres): 0.18 acres
Subdivision name or site address (include phase/lot number): 246 Springwood Dr.
which comprises lot 15 and % of lot 16 in the Fairway Shores -North development
Directions to site - please include road names and numbers, landmarks, etc.:
Hwy 24/27 west out of Troy to Hwy 73 at Lake Tillery. Lefton Hwy 73 east to Lilly's
Bridge Rd. Right on Lilly's Bridge approx. 5 miles to Springwood Dr. Right on Springwood to
246 Springwood Dr. (blue house on right).
Latitude (in decimal degrees) 35.244781 Longitude (decimal degrees) -80.076110
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Developed residential
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): To replace existing 30+ year old wooden seawall for
improved shoreline stabilization.
7. Will work be conducted from land? ❑X From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
150 square feet (75 feet long x 2 feet deep)
Temporary impacts in square feet:
None
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
375 square feet (75 feet long x 5 feet wide into lawn)
Temporary impacts (temporary clearing, construction corridor) in square feet:
1200 square feet (120 feet long x 10 feet wide construction corridor)
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): Lawn adiacent to existing
seawall will be removed but then re -seeded. No other vegetation will be impacted
11. Signature
Owner/ s Signature' [15A NCAC 02H .0502(f)l Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

a
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
Lake
Full Pond/ Normal Water Leve
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Shoreline 75' 6X/sr/ s�i1�Rt�
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Plan View
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FORM: SSGP 02-2017
Lake
lAa NO Pond/ N01114 Wald Lx vFf Existing Dock
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3hc150ftpillow h.a 0-61 NWL
Full Pond/ Normal Water Levelnhoreoner .150h
Riprafull pond/ NWL
2 h. � 150 RIt --ry
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Plan View
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Page 3 of 4

Lake
(At Full Pond/ Normal Water Levee
Side View
10 ft. bank
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3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
`if necessary
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Existing bank
FORM: SSGP 02-2017 Page 4 of 4
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FORM: SSGP 02-2017 Page 4 of 4
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3 ft. below full pond water level 4 ft. above full pond water level 2 ft. additional clearing
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FORM: SSGP 02-2017 Page 4 of 4

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Survey for
HENRY J. PERSIA & WIFE,
MARY E. PERSIA
Lot No. 15 & 1/2 of Lot No. 16 in the FAIRWAY SHORES Development
Pee Dee Township, Montgomery County, North Carolina
Deed Reference Book 196 Page 815; Plat Cabinet A Slide 466.
Surveyed by Thomas J. Fields, PLS -2906, in April 2017
REVISED & UPDATED on May 4th, 2017.
TOTAL AREA = 0.18 Acre f
by coordinates
50 0 50
Scale is in Feet
1 = 50'
QAa rb S From the office _
WRIGHT &FIELDS LAND SURVEYING
303 WEST SPRING STREET
dell AWIMM"'Ib TROY, N.C. 27371
Found:
1 1/2" Iron
Pipe
.c IV. V�L' "O MAGNETIC
Lake Tillery /� NORTH
2� Feb. 2002
o Found:
o
W 1/2' Iron Lot No. 17
6 ° v0�� Rod
! X16 \e� Qi Found: 1"
'0!e 6Oor 2 N Iron Rod hof ,yo. of /
existing nOr'se S j0, /6
pier � `i3',js.
s�+a Duke 8 Bl Fr e 120 24 Fr 3/4unldron
Energy N 18'40'53" E Pipe /
Property oryA, 21.82 FT ae /
�e
V, b a l v concrete /
Found: 5/8' ` �j258/ne ^ o, 1 °a eF parking /
Iron Rebar o o
Found: N 10.4 o O
j B
Fr
Tie Line Rebar
on 25g'5 concrete
3 25 00 FT W Found: 1" W98.45 Fr parking / S 41*37'77.741 FT W
Iron Pipe
Lot No. 14
6 e /
Found:
MINIMUM BUILDING SETBACKS 00
/ 3/4" Iron
Front . . . . . . . . 30 Feet d / Rebar
Sides . . . . . . 10 Feet Found:
Lakeside . . . . . . 10 Feet 5/0' Iron /
Rebar GJ
Symbol Legend
NORTH CAROLINA
MONTGOMERY COUNTY
I, Thomas J. Fields, certify that this plat was
1111111 t
prepared,by me inrespects correct
2017 from an actual
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andisuinealldone
belief. The
`�`�`eST� �
to the best of my knowledge and
p�;;OFESS/O",
ratio of precision as calculated by latitudes and
departures is 1:15.000'+ . This plat was
prepared In accordance with Board Rule .1600
-_ SFAL —_
Witness my original signature and official stomp
— L-2906
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this the 4th day of May 2017
O `9 q--4
PLS-29MSURVEYOR 0
t//t111111 �t1t
No horizontal control within 2000 feet.
NOTE: This property is not located in any FEMA special flood hazard area.
0 ...... denotesmonuments found
or set as noted on plat.
A ...... denotes measured points;
no monuments found.
ITE
ttjs J 111
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1173
LAKE
11LLERY
NIS
VICINITY MAP
Job No. 2017-67

B.3 Photos of 246 Springwood Dr., Mt Gilead
Existing 75 Foot Seawall on Lake Tillery to be Replaced