20210233 Ver 1_Shoreline Stabilization_20210326

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.pdf 49.94KB
Pre -fling Meeting or Request Date 3/24/2021
ID# 20210233
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:*
Email:
*
Phone Number:*
Mailing Address:*
[e-mail]
Rease provide an email address for payrrent and requests for pore information here.
Robert Moye
robertmoye@yah oo. c om
[phone]
(xxx)xxx-xxxx
Street Address
164 Eagle Chase Lane
Address Line 2
CitY
Denver
Rbstal / Zip Code
28037
State / Rovince / Region
NC
Country
United States

Is there an agent working on the
project?*
Agent/Consultant Information
Name:*
Company Affiliation:*
Email: *
rr Yes
r No
Dean Fisher
Lake Norman Custom Dock & Pile Driving, Inc
[e-mail]
Phone Number:* [phone]
(xxx)m-
Mailing Address:*
Street Address
P.O. Box 1439
Address Line 2
C7ty State / Province / Region
Denver NC
Fbstal / Zip Code Country
28037 United States
Asigned and dated copy of the Agent Authorization letter:*
Moye
30.57KB
AGENT AUTHORIZATION FORM.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Moye Shoreline
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.*
C' Upload File
C Look up address
Upload Map: 164 Eagle Chase Ln - Google Maps.pdf 366.86KB
Latitude:* 35.658131
Longitude:* -80.936231
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*
layout.pdf
site plan.pdf
Please use the diagram at the link below:
10.6KB
94.66KB
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.)*
photo 1.jpg 1.49MB
photo 2. jpg 1.71MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Troutman
County:* Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 164 Eagle Chase Ln / lot number 56
Include phase/lot nurrber
Directions to site:*
Take NC-150 E towards Mooresville. Turn left onto Perth Rd. Turn left
onto State Park Rd. Turn left onto Wildlife Rd. Turn right onto Sierra
Woods Dr. Turn left onto Deer Run Dr. Turn right onto Eagle Chase Ln.
Rease include road narres and nunbers, landrrarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
residental
Residential, undeveloped, etc.
6. Property Size
0.76
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Grading, clearing and backfill along approx. 110ft shoreline. Installation
and grading of approx. 6x150ft along shoreline for Rip Rap with fabric
with repairs.
8. How will the work be done?*
rJ From Land
r 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.)
450 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, backfill, excavation, rip rap, retaining walls, etc.)
1,950 sq ft
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:
layout.pdf 10.6KB
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
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:
Dean Fisher

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210233
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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO, 56 PLAN NO. PARCEL ID: 4720-40-9028
STREET ADDRESS: 164 Eagle Chase Ln Troutman NC 28166
Please print:
Property Owner: Robert Moye
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher , of Lake Norman Custom Dock & Pile Driving, Inc
(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):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
7 f
'Authorized Signature
'
Date: `-/ Z1 --/
Authorized Signature
Date:

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DWR Pre-Fil ing Meeting Req u est Form
Contact Name *
Contact Email Addre ss *
Proje ct Owne r *
Proje ct Name *
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.
Ple ase attach the docume ntation you would like to hav e the me e ting about.
Dean Fisher
[e-mail]
Robert Moye
Moye Shoreline
Iredell
City
Troutman
State / Province / Region
NC
Postal / Zip Code
28166
Country
USA
Street Address
164 Eagle Chase Ln
Address Line 2
Yes No
401 Water Quality Certification -
Regular
401 Water Quality Certification -
Express
Individual Permit Modification
Shoreline Stabilization
Yes No
Alan Johnson
Grading, clearing and backfill along approx 110ft shoreline.
Installation and grading of approx 6x150ft along shoreline for Rip Rap
with fabric with repairs.
2/9/2021
2/10/2021
pdf only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
Signature *
Submittal Date
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.
2/2/2021