20210217 Ver 1_Shoreline Stabilization_20210305

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TINE
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 view the form.
Attach documentation of Pre -Filing Meeting Request here:
DWR Pre -Filing Meeting Request Form
55.71 KB
(34).pdf
Pre -fling Meeting or Request Date 1/30/2021
ID# 20210217
I. Applicant Information [15A NCAC 02H .0502(a)]
Version 1
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: *
[e-mail]
Rease provide an email address for payment and requests for more information here.
Paul D Stokose & Christina M Campbell
Email:* [e-mail]
Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
8030 Shipp's Lane
Address Line 2
City
Denver
Rasta) / Zip Code
28037-8685
State / F1 ovine / Region
NC
Country
US

Is there an agent working on the
project? *
Agent/Consultant Information
.......................................................................................................
Name:*
Company Affiliation: *
Email:*
Phone Number:*
Mailing Address:*
• Yes
✓ No
Beth Mosteller
Dale & Beth's Lake Use Permit Service
[e-mail]
[phone]
(xxx)m-
Street Address
988 Clear Creek Circle
Address Line 2
City State / Province / Region
Lincolnton North Carolina
Fbstal / Zip Code Country
28092 United States
Asigned and dated copy of the Agent Authorization letter:*
Agent.pdf
Catawba Indiana.pdf
Link to: Sample Agent Authorization Form
389.03KB
686.88KB
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Stokose Shipps Lane
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 haee 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
Upload Map: plat.docx 13.09MB
vicinity.docx 2MB
Latitude:*
35.466130
Longitude:* -80.981030
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*
drawing.docx 188.54KB
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.)*
pictures.docx 35.82MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Denver
County:* Lincoln
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* F L & ARBlack Lot 16 & 17 & Adj1289
Include phase/lot number
Directions to site:*
from 526 S Church St Charlotte NC, get on I-277S, follow NC-16N to
Optimist Club Rd in Catawba Springs, continue on Optimist Club Rd, take
Graham Rd to Shipp's Ln
Rease include road nacres 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 1.289
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
place Class B rip rap along 207 ft following the contour of shoreline
8. How will the work be done?*
17 From Land
rJ 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.)
207
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.)
207
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nurrber of trees, for instance)
no trees to be removed, fescue grass
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):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
o $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");
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:*
Signature:
Beth Mosteller

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210217
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Version:* 1
Alan Johnson:eads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
C' Need Fee - send electronic notification
C' $240.00
r $570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 16 & 17 & Adj PLAN NO. PARCEL ID: 4613001490
STREET ADDRESS: 8016 Shipps Lane, Denver NC 28037
Please print:
Property Owner:
Paul David Srokose & Christina M Campbell
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):
8030 Shipps Lane, Denver, NC 28037
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
uthorized"Signaure
Paul Dav�d/Sr_okgs� C
Date: ! - I
ld
Authorized Signat
Christina M Campbell

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 8016 Shipps Lane, Denver NC 28037 C' nty: Li
Owner: Paul David Srokose & Christina M Cam • bell
Print
Contractor/agent: Beth Mosteller
Print
Q
S ture
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 Paul David Srokose & Christina M Campbell 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 (owner):
Signature (owner):
Date:
Date:

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GRAPHIC SCALE - FEET

I
p Scale: l inch.100 feet

water
207 ft shoreline
3 ft below
1 ft above

DWR Pre-Fil ing Meeting Req u est Form
ID#*Ve rsion *
Re gional Office *
Re v ie we r List *
Contact Name *
Contact Email Addre ss *
Proje ct Name *
Proje ct Owne r *
Proje ct County *
Owne r Addre ss:
Is this a transportation proje ct?*
Type (s) of approv al sought from the DWR:
Doe s this proje ct hav e an e xisting proje ct ID#?*
Do you know the name of the staff me mbe r you would like to re que st a me e ting with?
Ple ase giv e a brie f proje ct de scription be low.*
Please give a couple of dates you are available for a meeting.
20210217 1
Mooresville Regional Office - [phone]
Alan Johnson
Pre-Filing Me eting Reque st submitte d 1/30/2021
Beth Mosteller
[e-mail]
Srokose Campbell
Paul David Srokose & Christina M Campbell
Lincoln
City
Denver
State / Province / Region
North Carolina
Postal / Zip Code
28037
Country
United States
Street Address
8016 Shipps Lane
Address Line 2
Yes No
401 Water Quality Certification -
Regular
401 Water Quality Certification -
Express
Individual Permit Modification
Shoreline Stabilization
Yes No
place Class B rip rap along 207 ft following the contour of shoreline, 1
ft above full pond and 3 ft below full pond , lot number for property is
16 & 17 & Adj
Ple ase attach the docume ntation you would like to hav e the me e ting about.
Signature
Submittal Date
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.
· 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.
1/30/2021