20210049 Ver 1_Shoreline Stabilization_20210216

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:
Herrema Pre -Filing Form.pdf 51.51KB
Pre -fling Meeting or Request Date 1/7/2021
ID# 20210049 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 *
Owner Information:
Name:
*
Email:
*
Phone Number:*
Mailing Address:*
[e-mail]
Rease provide an email address for payment and requests for more information here.
Don Herrema
djherrema@gmail. com
[phone]
(xxx)xxx-xxxx
Street Address
19109 W. Catawba Ave.
Address Line 2
Suite 200
city
Cornelius
Fbstal / Zip Code
28031
State / Frovince / Region
NC
Country
United States

Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name:*
Randy Jordan
Company Affiliation:*
Lyfe Marine
Email:*
[e-mail]
Phone Number:*
[phone]
(XXX)XXX-XXXX
Address:*
Street Address
19109 W. Catawba Ave.
Address Line 2
Suite 200
City
Cornelius
Fbstal / Zip Code
28031
Asigned and dated copy of the Agent Authorization letter:*
Herrema Agent Auth.pdf 75.66KB
Herrema Catawba Riparian.pdf 91.77KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* HerremaShoreline
State / Province / Region
NC
Country
United States
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.
r Upload File
F Lookup address
Property Address Lookup:*
Latitude:* 35.466725
Street Address
16780 Green Dolphin Lane
Address Line 2
City
Cornelius
Fbstel / Zip Code
28031
State / Province / Region
NC
Country
US
Longitude:*-80.930456
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*

Herrema Diagram.pdf 289.04KB
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.)*
Herrema Photo Ljpg 5.97MB
Herrema photo2.jpg 6.01MB
Trees 1-4 Herrema.jpg 3.92MB
5th tree Herrema.jpg
3.88MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Cornelius
County:* Mecklenburg
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* Lot 115B 16780 Green Dolphin Lane, Cornelius, NC 28031
Include phase/lot nunber
Directions to site:*
77N to Exit 28; turn left onto Catawba Ave to right onto Jetton to left
onto Harbor Light Blvd to left onto Yawl to right onto Green Dolphin.
16780 is on the left.
Rease 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, vacant lot
Residential, undeveloped, etc.
6. Property Size .523
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Remove 5 undermined tress and stumps at the shoreline. Shape the bank,
instal geo-tech fabric, install Class "B" rip rap.
8. How will the work be done?* I7 From Land
r 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.)
900
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
100
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)
Grass, trees, vacant lot
Sketch: Herrema Diagram.pdf 289.04KB
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:* Randy Jordan
Signature:
1?a14d1,T0I b1014

Initial Review
Is this accepted into the review
process?*
Project Number:* 20210049
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

SAMPLE AGENT AUTHORIZATION F("
PROFUM LEGAL DE9CREMON:
L r riv.PLAN NO. PARCEL m
STREET ADDREW.
� o�: - -- --- -
me ►mdastq�ed, propartY arrriers d the abMe naoea ohm, dD � aumorm
cr \"S*- -
(Contradjur I AMC) o me Of oor Rw*V wm)
to awl on nTi b~ aW take al aWor s nWemry for tt+r p wmsft mm" and wManoe d
&m permit or o ufkmW and any and as vxvLerd and sapeWl tordWac W&dmL
P►� Owens Address (k draw* Than prWa ty abo%e):
T ww
���- '�►gyp - b �]`
%* hereby cw* the ab a Wannabon snub, in Ns appk on is mm and acaraee to ft
beset of *x krrcwled
�� ►i,eAl�rtaed 9�e
D": Xti z.& 7nt Date. --

r
Ir
CATAWRA RIPARIAN BUFFER NOTIFICATION FORM
Pmom molowl ; �I-wl/
r
The avororal is for Vw purpose and des+ + desufad in your apphc tion. rrnprcts not wdar;& e W thin
aPPN" Wn is a vWist»n of the tl d* Rule. Sne speck work t xmAd be provided on the appkahm (ISA WCAC
D2ti _0506 and 15A NCAC 028 _0243(8l1
Trees are not srkwed to be removed frpm Tone t of the %ow (Mom 30 ft of the IW pond evvmionl, u Mt!!a
aPPrVded_ lVZePtWn- thM trees that Aft K%Vtrty WKkrMkWd fora the W wedirtr Owofebw can be ranored.
Mkgn%W shapWI and sk*tg SAW* the Onmrd4te shorellnt is ab wad. I15A W—ANC 02B .024XQI
Berrdtirlg and IP N& 18 in the buffer is not aftwed. Eace-rsrvr dr awbance of un," hove+. 115A NCO-C 02B .0243
(61l qq
Beaches. knMrvkMA patio's. impervious rraMtways, ttc. are rot a+f awed in &* buffer unkms s xKftmAy approved
by the OfttWn. Them are tun nation on sire for deda. I15A "CACtarn jW43(4) and (6)1
War* to be conducted Iron, Land must Indscaty an omwu and kwkste any trees that are to be removed The
work caeridw slwxAd be descrftd Tht approved access cor*idvr sfsafl be nmored. 5i *nL spod. strrutructioe
ffwbW al must be outside the buffer. IVSA NCAC 02k DW arrd I%A WLAC 028 A213 (4), (61. (Sil
Stofrnwater cant be piped or charanekd for drred dmct%arge to the lake All constructed %jonrwalrr
&wNwBrs must be at the natural Arvabon and dssdsarprd poor to entering the buffer dwrrctvd at ddfusr nr
Sheet flow at mon vnrJm w4oatrrs to the lake. I35A WCAC 02B ,0243(SI. (6)I
here" state that 1 hove been reformed of the Catawba
Rkm rkm Bef'lltr Rule. Arty wed conducted In the buffer, not specWka*y stated on the appotstion and approved
by the Wirbian d Water Rdorrces (DWRI, is a vbkawn and sarbject to enlorcement. Due dl4tncr with be
taken suds dot the ounaruction wiR br butt n sukManhal cornpkancr and Intent of ft 401 Water
QuaRty Cert0kation and Tr Rsies, t1y� proved pion[ s} and spctiiFinetior►IsI, and other suppoet"
rrlatt}rialt. �f

Full Pond/
Normal Water Level
noM7��
Shoreline
4-
�G�
Lake
(At Full Pond/Normal Water Level)
ISM
� ■nr � �. i_
Please approximately sketch the following information on this plan, length of shoreline
(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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Full Pond/
Normal Water Level
noM7��
Shoreline
4-
�G�
Lake
(At Full Pond/Normal Water Level)
ISM
� ■nr � �. i_
Please approximately sketch the following information on this plan, length of shoreline
(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

ID#* 20210049
Version* 1
Regional Office * Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 1/7/2021
Contact Name* Kim Jordan
Contact Email Address* [e-mail]
Project Name* Herrema Shoreline Project
Project Owner* Don Herrema
Project County* Mecklenburg
Owner Address: Street Address
16780 Green Dolphin
Address Line 2
aty State / Province / Pegion
Cornelius NC
Postal / Zip axle Country
28031 United States
Is this a transportation project?* r Yes (' No
Type(s) of approval sought from the DWR:
* 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
* Individual Permit F Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- No
Do you know the name of the staff member you would like to request a meeting with?
Alan Johnson
Please give a brief project description below.*
New shoreline stabilization w/ Class "B" Rip Rap; approx. 100 LF
Please give a couple of dates you are available for a meeting.
1 /8/2021

1 /15/2021
Please attach the documentation you would like to have the meeting about.
pdf 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.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
1 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
Submittal Date 1/7/2021