20201572 Ver 1_Shoreline Stabilization_20201201

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:
20201572 Ver 1 PreFiling Email 30-Day
694. SSKB
Clock Reached Email 20201123.pdf
Pre -fling Meeting or Request Date 10/23/2020
ID# 20201572 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 er ail address for payment and requests for more infornation here.
Owner Information:
Name: * Susan L Gerdon
Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
211 Haywood Drive
Address Line 2
City
State / F rovince / Fbgion
Lincolnton
North Carolina
Fbstal / Zip Code
Country
28092
United States

Is there an agent working on the
project?*
Agent/Consultant Information
.................................................................................................................
Name: *
Company Affiliation:
Email:*
Phone Number:*
Mailing Address:*
r Yes
r No
Beth Mosteller
Dale & Beth Lake Use Permit Service
[e-mail]
[phone]
(XXX)XXX-XXXX
Address
988 Clear Creek Circle
Address Line 2
Cty
Lincolnton
Fbstal / Zip Code
28092
Asigned and dated copyof the Agent Authorization letter:*
Agent Form.pdf 362.4KB
Catawba Form.pdf 640.58KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Gerdon
State / Province / Region
North Carolina
Country
United States
If your project has a formal name please use this. If your project does not haw 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
Property Address Lookup:* Street Address
753 Kemp Road
Address Line 2
City
State / Province / Plegion
Mooresville
NC
Fbstal / Zip Code
Country
28117-6625
US
Latitude:* 35.566424
Longitude:*-80.947923
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*
Abbreviated PCN shoreline page 3.docx 140.47KB

Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/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.)*
pictures.docx
35.2MB
vicinity.docx
2.09MB
plat.docx
936.08KB
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:* Crescent Land & Timber Lot 176, 753 Kemp Road Mooresville NC
Include phase/lot number
Directions to site:*
from 526 S Church St, get on I-277 S, follow I-77 N to NC-
I 100/Brawley School Rd in Davidson, take exit 35 from 1-77 N, continue
on NC- 1100/Brawley School Rd drive to Kemp Road
Pease include road narres and nunbers, 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 0.82
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
due to wave action
8. How will the work be done?* 17 From Land
17 From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
199
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.)
199
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)
grass fescue
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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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');
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:* Beth MosteHer
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201572
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 176 PLAN NO. PARCEL ID 4626-06-7726
STREET ADDRESS: 753 Kemp Road, Mooresville, NC 28117
Please print:
Property Owner: Susan L Gerdon
The undersigned, registered property owners of the above noted property, do hereby authorize
Beth Mosteller , of Dale & Beth's Lake Use Permit Service
(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):
211 Haywood Drive, Advance, NC 27006
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date:

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 753 Kemp Road Mooresville, NC 28117 County: Iredell
Owner: Susan L Gerdo
Print
Contractor/agent: Beth M
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)]
Benching, 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 02B .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
I, Susan L Gerdon 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 spe
Signature (owner):
and other supporting materials.
Date: /0 - d- Do

Division of Water Resources
Full Pond/
Normal Water Level
Shoreline
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
La ke
(At Full Pond/Normal Water Level)
0000000000000000000000000000000000000000
0000000000000000000000000000000000000000
0000000000000000000000000000000000000000
199 to follow contour of shoreline,
one foot above full pond,
and 3-4 feet below full pond
Susan L Gerdon
753 Kemp Road
Mooresville, INC 28117
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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ID#* 20201572 Version* 1
Regional Office* Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 10/23/2020
Contact Name *
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
Beth Mosteller
[e-mail] and [e-mail]
Gerdon
Susan L Gerdon
Iredell
Street Address
753 Kemp Road
Address Line 2
aty
Mooresville
Rbstal / Zip Code
28117
Is this a transportation project?* r Yes r No
Type(s) of approval sought from the DWR:
r- 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
r- Individual Permit r- Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
r Yes r No
State / Frovince / Region
NC
Country
United States
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below. *
rip rap redo Class B 199 feet to follow contour of shoreline, one foot above
full pond and 3-4 feet belowfull pond
Please give a couple of dates you are available for a meeting.
Please attach the documentation you would like to have the meeting about.
pdr only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
Kmrwo___
Submittal Date 10/23/2020