20201271 Ver 1_Shoreline Stabilization_20201028

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/26/2020 4:20:25 PM (Submittal)
Submit by Montalvo, Sheri A 10/28/2020 3:14:10 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 10/26/2020 4:20 PM

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to viewthe form.
Attach documentation of Pre -Filing Meeting Request here:
20201271 Ver 1 —PreFiling Meeting Not
74.52KB
Required Email 20201024 (3).pdf
Pre -fling Meeting or Request Date 10/26/2020
ID# 20201271 Version 1
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]
Rease provide an email address for payrrent and requests for rrore information here.
Owner Information:
Name:* Jason Walser
Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
8 Pine Tree Road
Address Line 2
City
State / Ravine / Fbgion
Salisbury
NC
Fbstal / Zip Code
Country
28144
Rowan

Is there an agent working on the (-' Yes
project?* O No
Agent/Consultant Information
Name: *
Terri Kindley/ Shannon Miller
Company Affiliation:*
Lake Norman dredging
Email:*
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
PO Box 3156
Address Line 2
City
Mooresville
Fbstal / Zip Code
28117
Asigned and dated copy of the Agent Authorization letter:*
2020-10-26 16.01.28.pdf 304.62KB
Link to: Sample Agent Authorization Form
State / Province / Fbgion
NC
Country
Iredell
Project Information [15A NCAC 02H .0502(a) & (b)]
.......................................................................................................................................................................................
Project Name: * 4719 & 4725 Kiser Island Rd Shoreline stabilization maintenance
If your project has a formal name please use this. If your project does not hake 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.*
F Upload File
r Lookup address
Upload Map: 87DF3197-5C2F-44CD-B15D-
574.96KB
D090368F93AE. jpeg
Latitude:* 35.562910 Longitude:*-80.966110
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*
76FB9868-52F2-41F8-8F92-
798.07KB
83F01 F49F7C2. jpeg
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.)*
EDOE957B-A2CE-4F22-9299-
682.1 KB
67B2651 C2135D. jpeg
BF12CB36-527A 40EE-91F9-
1.29MB
OE6C3785C1E7.jpeg
4. Location of the property (where work is to be conducted)
Nearest Town:* Terrell
County:* Catawba
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 4719 & 4725 Kiser Island Rd
hclude phase/lot number
Directions to site:*
177 exit 36 NC-150 toward Lincolnton 6.5 miles
Left onto Kiser Island Road 2.3 miles
Rease 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
Fbsidential, undeveloped, etc.
6. Property Size 4719=0.54 acres 4725=0.59 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Maintenance to existing Rip Rap between his two properties
to bare and eroded areas using Rip Rap. All work to be done
by water using barge and long reach.
8. How will the work be done?* r From Land
V 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 w alls, etc.)
680 sq ft
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.)
None
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees; for instance)
None

Sketch: 4FB53440-CE03-4C75-9451 -
656.38KB
A72E37E7C92D.jpeg
9EB5A034-DEB4-4401-B230-
3.45MB
84262286BBC5.jpeg
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):
$240.00 for impacts to lake (below normal water level) of less than 1 acre
$570.00 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');
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:* Terri Kindley
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201271
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
r Yes r No
Version:* 1
Alan Johnson:eads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
F Need Fee - send electronic notification
* $240.00
r $570.00

A-1,31-7PIT RIM
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LOT NO: PLAN NO: PARCEL.
ID:
STREET ADDRESS:
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ideas print:
Property
Owner:
Property
Owner.
The undersigned, registered property owners of the above noted property, do hereby
authorize
ofG-
(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 amv and all standard and special conditions
attached.
iProperr"of Ovinerrs Address (if c3iiVeren't :'han property above):
C'_ .:� R / e---1
Telephone: —7 C)4 ` q 9 L 6a 0,5
We hereby certify the above information submitted in this a '°- itior is tr:tQ erhO
ur i�noty[ e
accurate tothe best .
t

1396
150 1304
1219 1180
Lake Norman 1168
of Catawba
�F 1178
4725 Kiser Island
Rd 1179
� 1112
1193
1377
2153
►tport
1100 1267
Jetton
OMMPWO i-
Mt Mo
Q
�I David:
f�
Cornelius
4725 Kiser Island Rd
4725 Kiser Island Rd, Terrell, NC 28682

Temporary impacts (temporary clearing. construction condor) in square feet:
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):
11. Signature
Owner/Agent's Signature H SA NCAC 02H .0502(f) Date
Agent's signature is valid only if an authorisation letter
from the owner is provided
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 mp 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 Full Pond/ Normal Water Level)
I Si/ xj �C�k
IGf�Sy %
Plan View
SLIP

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C
Side ViewCL
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�A7AWRA RIPARUN MLMR N'--O-N FORM
ProjectNmne/address:�7i County:
Droner:A",-tt I �-e'�-
Print_`_
Contractorlaprnt: _ I I��(� (�
Print
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)1
Trees are not allowed to be removed from Zone 1 of the Buffer (-Mth in 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 inunediate shoreline is allowed. f15A NCAC 02B .0243(6)]
Benching and grading in the but%r is not allowed. Excessive disturbance of ground cover. [I5A NCAC 02B
.0243(6)]
Beaches, impervious patios, impervious walkways, etc. are not alloyed in the buffer unless specifically
approved by the Division There are limitation on size for deck. [15ANCA.0 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 02B .0243 (4), (6), (S)]
Stormtivater 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. f 15A NCAC 02B .0243(5), (6)]
Aeknmv1edgv-naa of Alofification
I. S" ✓i . hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Any work conducted in the buffer, not specifically stated in the application and approved
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 specification(s), and other supporting materials.
Signature (otivne Date: ,/� 6