20210477 Ver 1_Shoreline Stabilization_20210407

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:
Pre -Submittal Meeting Request Form.pdf 410.07KB
Pre -fling Meeting or Request Date 3/1/2021
ID# 20210477
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 Safrit
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
2990 Rockwell Rd
Address Line 2
CitY
Rockwell
Rbstal / Zip Code
28138-8781
State / Rovince / Region
NC
Country
US

Is there an agent working on the
project? *
Agent/Consultant Information
.......................................................................................................
Name:*
Company Affiliation: *
Email:*
Phone Number:*
• Yes
✓ No
Janice Estep
CBC Stone & Recycling, LLC
[e-mail]
[phone]
(x)m-
Mailing Address:* Street Address
638 Oakridge Farm Highway
Address Line 2
City State / Province/ Legion
Mooresville NC
Fbstal / Zip Code Country
28115-7947 United States
Asigned and dated copy of the Agent Authorization letter:*
Auth. Form.pdf 219.47KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Safrit 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.*
✓ Upload File
✓ Look up address
Upload Map:
Latitude:*
Survey.pdf 337.77KB
Vicinity Maps.pdf 1.96MB
Directions.pdf 233.51KB
35.546487
Longitude:* -80.892276
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*
Site Plan.pdf
Buffer Form.pdf
Please use the diagram at the link below:
362.83KB
374.26KB
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.)*
Shoreline Pics.pdf 2.14MB
4. Location of the property (where work is to be conducted)
Nearest Town:*
County: *
Lake/ river/ ocean adjacent to
property:
Mooresville
Iredell
Norman
Subdivisions name or site address: * 134 Surfside Rd. Mooresville, NC 28117 Lot 90 Commodore Peninsula
hclude phase/lot nurrber
Directions to site:*
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
20 s (197 ft)
Take E Wilson Ave and NC-1100/Brawley School Rd to Stutts Rd in
Davidson
15 min (6.5 mi)
Turn right onto E Center Ave
0.5 mi
Turn left onto S Church St
0.4 mi
Turn right onto E Wilson Ave
1.5 mi
Continue onto NC-1100/Brawley School Rd
1.0 mi
Continue straight to stay on NC-1100/Brawley School Rd
3.2 mi
Continue on Stutts Rd. Drive to Surfside Rd
4 min (1.9 mi)
Turn left onto Stutts Rd
1.5 mi
Turn left onto Commodore Loop
0.2 mi
Turn right onto Surfside Rd
Destination will be on the right
0.1 mi
134 Surfside Rd
Mooresville, NC 28117
Rease include road narres and nurrbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*

Residential
Fssidential, undeveloped, etc.
6. Property Size
0.23
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Install Redi Block wall to replace existing wall
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.)
3.5' below (483 sf)
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.)
1' above (138 sf)
10' x 50' access
corridor (500 sf of
temp. impact)
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 buffer, no trees removed, minimal disturbance to buffer
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:
Janice Estep
cAt (j Q 44r.

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210477
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. qo PLAN NO. PARCEL ID:
STREET" ADDRESS: [ 3 Li SurFS1d €. Ln
8ore5 \i',, l (e 1NiC 28117
Please print: i
Property Owner: loL er+ SaFr rl
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
JXtCe LS-kip
(Contractor / Agent)
of Cad( 5Ior?e e aecc3er79 /AC
(Narne 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):
2gga Ptoctwell wel1(fkC Z8(38
Telephone: 104 - `j q(, (p q (o 5
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorize Signature
Date: 2/ a ce'a
Authorized Signature
Date:

D+S
DON ALLEN & ASS OCIATES, F. A.
"Since 1971"
Commercial * Residential * Mortgage Surveys * Mufti -Family
Construction Staking * Subdivision Design * Topographical
131 Crosslake Park Drive -- Suite 102 * Mooresville * NC * 28117
[phone] [phone] Fax
I, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded in deed book 2671 page 466 , and/or
plat book 7 page 3 _ that the ratio of precision is 1':10,000, that this mop
was prepared in accordance with the General Statutes of North Carolina Chapter 89C.
my hand and seal on the 1 day of APRIL
A.D. 20 21
BRAWLEY SCi-1. RD.
VICINITY MAP
St.lfftoe.
QR
NO SCALE
`.
' ETP
LOT 88
BOBBY At
SAFRIT
1788/1134
mmonnwie
E:P N88'57'46"W
64.58'
(11E ONLY)
R/W
LEGEND
17
z
m
w
Er) o
asn
CP = CCMPu1EO POINT
EI.P. = EXISTING IRON FOUND
I.P.S. 4 REAR SET
R/W = RIGHT-OF-WAY
**LAKE
NORMAN**
CONCRETE
SEA WALL
780 CONTOUR LOCATED
PER ACTUAL FfELD SURVEY
}�\ 50' BUU
ifr
N89'01'35"W
oP 98.55' TOTAL
OP
-----S88'58'03"E
140.46' TOTAL
SURFSIDE DRIVE
(60' R/W)
,Ildi� rri..wyn�
WILLIAM . M. A •L,Etti ,GIck>g'•,,�a
•fl�� SSJO
-
SEAL 1
1,3499 Ae
R/W 1)
0' 20' 40' 100'
� u
SCALE IN FEET
BOUNDARYSURVEY
2)
3)
4
5
OF
134 SURFSIDE RD
LOTS 89 & 90 COMMODORE PENINSULA
0
0
a
v,
m
LOT 91
MULTIPLE OWNERS
OF COMMODORE
PENINSULA
683/79
EIP
NOTES
THIS PROPERTY MAY BE SUB,ECT TO
ANY EASEMENT AND/OR RIGHTS -OF -WAY
OF RECORD.
AREA COMPUTED BY THE COORDINATE
METHOD.
OIS1ING 760' & 781' CONTOUR ELEV-
ATION BASED ON LAKE NORMAN LAKE
LEVEL AT COWAN'S FORD DAM (READiNG
ON 3-24-21) ELEVA110N: 756.2
UNDERGROUND POWER
NO GRID MONUMENT FOUND WITHIN
2000 FEET.
SCALE 1' =,40' DAVIDSON TWSP., IREIDELL C0_, N.C.
ACQUIRED BY: B0B8Y M. SAFRIT II
FIELD BOOK: -
FIE; COMMODORE PEN 85-00.DWG
DC PILE:
TAl( MAP N0: 4635792104

r-
L
tpJBas 1
i__...
OD
143
143
75
Oa
r.
143
41' 133
225
204
259
143
CPL
171
'wJ
cr;
0,
0
z
z
20
ZAINO
out

POS

Continue an Stotts Rd. Drive to Surfside Rd
o
73
— — - •
(
co
/
env uosIIM 3 oluo I Lunt_
IS1l JnL3Soluo11a1uJnl
Continue onto NC-1100/Brawley School Rd
2. Turn right onto E Center Ave
(!wS'9)uiu 9l
1. Head south on Evergreen St toward E Center Ave
a
/
Li all g>.'sallw .1713 anua
90
50 C
\/ 0
3
o
0
Q \ J
Pii s11n1S oluo us' wnl 'L

Full Pond/
Normal Water Level
Shoreline
Lake
(At Full Pond/Norrnal Water Level)
3.5 ' 1oe_law 138'
a_bov e 7c l38'
13$' ieng-Eh
house
1
WWW MWM WAN MOW EWE
No trees rexnoved
rir i n mat d i s-1-urhq nce
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

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address
Owner; 1315b69 M. 3 r ��
Print , n, Signature
Contractor/agent: `~+ S n� �. �}� kick, lta.c
Print �J JJ
�ture
28111
= {3q Ju ).-s 1cie. Lri. i t oore5k.)°, r 1 f MC.. Coon
.-1�-red e l l
4
„k Cot 1'
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 0213.0243 (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 028 .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
helr+ 54Y`-ti" , 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 approve plan(s) and specification(s), and other supporting
materials.
Signature (owner): !
Date; Z---Lb —2.1

DWR Pre -Filing Meeting Request Form
ID4*
Regional Office *
Reviewer List*
20210477
Version* 1
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 3/1/2021
Contact Name * Janice Estep
Contact Email Address * [e-mail]
Project Name * Safrit Shoreline
Project Owner* Robert Safrit
Project County* lredell
Owner Address: Street Address
134 Surfside Lane
Address Line2
aty State / Frovince/ Region
Mooresville NC
Rastai / Zip Code Country
28117 United States
is this a transportation project? * Yes 17 No
Type(s) of approval sought from the DWR:
F 401 Water Quality Certification - r 401 Water Quality Certification -
Regular Express
F Individual Permit r Modification
Pi Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes r: 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.*
Install Alan block wall to replace existing block wall.
Please give a couple of dates you are available for a meeting.
3/2/2021

3/3/2021
3/4/2021
3/5/2021
3/8l2021
Please attach the documentation you would like to have the meeting about.
Safrit Shoreline.pdf 2.15MB
Pa
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 projects 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 3/1 /2021