20241304 Ver 1_Shoreline Stabilization_20240927

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Qualify
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
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.
Owner Information:
........................................................
Name: * Robert Cummings
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address: * Street Address
225 Cattle Ridge Road
Address Line 2
City State / Province / Region
Marvin NC
Postal / Zip Code Country
38173 US
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
Name: *
Company Affiliation: *
Email: *
Phone Number:*
Brad Bustle
BBC Construction
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address: *
Street Address
3884 LAKE BREEZE DR
Address Line 2
City State / Province / Region
SHERRILLS FORD catawba
Postal / Zip Code Country
28673 United States
A signed and dated copy of the Agent Authorization letter:*
Rob Cummings auth form DWR.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC O2H .0502(a) & (b)]
Project Name:*
Cummings shoreline Beachside Place
559.82KB
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: * 35.546526
Street Address
5040 Beachside P1
Address Line 2
City State / Province / Region
Sherrills Ford NC
Postal / Zip Code Country
28673-8210 US
Longitude: *-80.978694
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 *
site
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.)
4. Location of the property (where work is to be conducted)
Nearest Town: * SHERRILLS FORD
County: * Lincoln
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: *
5040 Beachside Place Sherrills Ford, NC 28673
Include phase/lot number
Directions to site: *
NC-16 N (W Brookshire Fwy).
Keep right onto Brookshire Blvd (NC-16 N). Go for 89 ft.
Then 0.02 miles
Keep right onto Brookshire Blvd (NC-16 N). Go for 14.9 mi.
Then 14.9 miles
Turn right onto St James Church Rd. Go for 1.2 mi.
Then 1.2 miles
Continue on Will Proctor St. Go for 0.5 mi.
Then 0.5 miles
Turn right onto Campground Rd. Go for 0.6 mi.
Then 0.6 miles
Turn left onto Campground Rd. Go for 1.3 mi.
Then 1.3 miles
Continue on Slanting Bridge Rd. Go for 0.5 mi.
Then 0.5 miles
Turn right onto Keistlers Store Rd. Go for 0.3 mi.
Then 0.3 miles
Turn left onto Mountain Shore Dr. Go for 0.5 mi.
Then 0.5 miles
Turn right onto Channel Dr. Go for 466 ft.
Then 0.09 miles
Continue on Channelview Dr. Go for 0.1 mi.
Then 0.1 miles
Turn left onto Waterside Cir. Go for 210 ft.
Then 0.04 miles
Turn right onto Beachside Pl. Go for 236 ft.
Then 0.04 miles
5040 Beachside PI
Sherrills Ford, NC 28673-8210
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
0.643
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Slope eroded shoreline. Add fabric and rip rap to stablize.
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.)
1010
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.)
1270
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 disturbance of vegitation
Sketch: Robcummings side view DWR.pdf 391.49KB
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 $323.00 for impacts to lake (below normal water level) of less than 1 acre
o $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");
o 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:* Brad Bustle
Signature:
ietaa' OAP*
Submittal Date: 9/20/2024

Initial Review
Is this accepted into the review process? * Yes No
Project Number:* 20241304 Version:* 1
Select Reviewer: * Jesse Mcdonnell:Jesse.Mcdonnell
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?*
$240.00 $570.00
$323.00 $767.00

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: /} (� [ f
LOT NO. PLAN NO. PARCEL ID: OC ! r�
STREET ADDRESS: 56 tio &'OChS/d( P1
herrti/s Ord INC ag.&;17-
Please print: bey Property Owner: Robert Co yvl iM 1 {1qS
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
brad , of B3C Cor ach'ne
(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 Owner's Address (if different than property above):
225 Cattle Ridge Rd. Marvin, NC 38173
Telephone: (0(53 51Q(0 (5
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
•Authorized Signature
Date: 09/18/2024
Authorized Signature
Date:

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North Carolina Department of Environmental Quality { Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center l Raleigh, North Carolina 27699-1617
919,707,9000

b.
c.
d.
e.
Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
Location of any proposed structures such as buildings, retaining walls, docks, etc.
Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal Water Leve
Share1ine
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Plan View
La ke
(At Full Pond/ Normal Water Level)
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Full Pond/ Normal Water Level
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2ft. x 150ft.
additional clearing
If necessary
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Plan View
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Lake
{At Full Pond/ Normal Water revel)
Existing Dock
30 ftx 7 ft
3 ft x 1.501t
8elawfull pond/NWL
��4frx 150ft
Above foil pond/ NWL
Rob Cu mnA inss
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

k Lake
(At Full Pon / Normal Water Le
Side View
NQ SD E
E
0
-
c
0
0
1_
aad\*of)al c\Ear„PS
N
w
0
,--eCbCunvruV
North Carolina Department of Environmental Quality { Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center l Raleigh, North Carolina 27699-1617
919,707,9000