20221033 Ver 1_Shoreline Stabilization_20220801

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 7/31/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
William Raymer
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
188 Beaten Path Road
Address Line 2
City
Troutman
Postal / Zip Code
28166
State / Province / Region
North Carolina
Country
United States
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name:* Donna P. Hrko
Company Affiliation: * Lancaster Custom Dock and Lift Systems, Inc.
Email: * [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
1156 Perth Road
Address Line 2
City State / Province / Region
Troutman North Carolina
Postal / Zip Code Country
28166 United States
A signed and dated copy of the Agent Authorization letter:*
Raymer Signed Agent Authorization Form.pdf 144.29KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Raymer Shoreline Refresh Adjacent Lots
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:*
35.579828
Street Address
188 Beaten Path Road
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-8978 US
Longitude: *-80.914358
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*
Raymer Detailed Site Plan and Misc. Docs.pdf 1.32MB
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.)
Raymer Photos.pdf 189.19KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Mooresville

County:* Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: *
188 Beaten Path Road Mooresville, NC 28117
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 35 Left onto Brawley School Road, Right onto Blume
Road, Left onto Beaten Path Road, Property is on the right.
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
Residential, undeveloped, etc.
6. Property Size
1.051 and .458 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shoreline refresh for stabilization and erosion control.
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.)
1680 sf
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.)
500 sf construction
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)
NONE
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");
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name: * Donna P. Hrko
Signature:
Submittal Date: 7/31/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221033 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

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 1 &2 PARCEL ID: 4637018405 &
4637017518
STREET ADDRESS:
188 Beaten Path Road
Mooresville, NC 28117
Please print:
Property Owner: William Raymer
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
DONNA P HRKO , of LANCASTER'S CUSTOM DOCK&LIFT SYSTEMS,
INC.
(Contractor/Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this
permit or certification and any and all standard and special conditions attached.
Property Owners Address(if different than property above):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best
of our kno e.
Authorized Signature Authorized Signature
7-15-2022
Date Date

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
(At FuIl Pond/Normal Water Level)o
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•Deed Ref. 1360 1 112-WD N❑T A LEGAL DOCUMENT
•Deed Date 20020805
•Tax Acres 0 Ac. Iredell County,North Carolina makes no claims and no
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•Lot# accuracy of the GIS data presented on this map.
•Plat Ref.
•Subdivision
•SD Phase
•Description OSTWALT 5R1443
•Old Parcel u 1702L00000A020
•Total Assessed $1,245,610
Value

Iredell County, North Carolina July 29, 2022
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•Total Assessed S375,520
Value

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: j ¢-6r ounty: 1 reAe,I
q+h • oQre&! II
owner: t 1 CA/ r
Print [ Sign
Contractor/agent: �r
Print Signature
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application, [15A
NCAC 02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer(within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be
removed, Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)1
Benching and grading in the buffer is not allowed, Excessive disturbance of ground cover. [15A NCAC 02B
.0243 (6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically
approved by the Division. There are limitation on size for decks. [15A NCAC 02B ,0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described.The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 028 .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non-erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
"
ti U l Qm RIONY-11er hereby state that l have been informed of the Catawba
Riparian Buffer Rule. Any wo conducted in the buffer, not specifically stated in the application and approved pp pp ed
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules,the approved plan(s) and specifications), and other supporting
materials.
Signature{owner): Date: !r J5 77

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