20202028 Ver 1_Shoreline Stabilization_20210416

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water QualityCertification, 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:
ChrisKDWQPreliminaryFinal.pdf 413.38KB
Pre -fling Meeting or Request Date 12/30/2020
ID# 20202028
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:*
mandyrenegarrealestate@gmail. com
Rease provide an email address for payrrent and requests for pore information here.
Christopher Kowalczyk
chriskowalskil 0@yahoo. com
[phone]
(xxx)xxx-xxxx
Street Address
117 Summersong Ln
Address Line 2
CitY
Mooresville
Rbstal / Zip Code
28117-8883
State / Rovince / Region
NC
Country
US

Is there an agent working on the
project? *
Agent/Consultant Information
..................................................................................................................
Name:*
Company Affiliation: *
Email:*
Phone Number:*
C' Yes
r No
Mandy Renegar
Renegar Construction - Admin
[e-mail]
[phone]
() -
Mailing Address:* Street Address
6026 Hwy 150 E
Address Line 2
City State / Province/ Legion
Denver NC
Fbstal / Zip Code Country
28037 United States
Asigned and dated copy of the Agent Authorization letter:*
ChrisKAthFormSignedDWQ.pdf 213.36KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Kowalczyk 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.*
r Upload File
C' Look up address
Property Address Lookup:*
Latitude:*
35.600998
Street Address
114 Summersong Ln
Address Line 2
City State / Frovince / F bgion
Mooresville NC
Fbstal / Zip Code Country
28117-8883 US
Longitude:* -80.928300
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*
ChrisKDWQSketchRevised.pdf 523.79KB
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.)*
ChrisKDWQPictures.pdf
2.69MB
4. Location of the property (where work is to be conducted)
Nearest Town:*
County:*
Lake/ river/ ocean adjacent to
property:
Subdivisions name or site address:*
Directions to site:*
77 N to Exit 36, turn left onto Hwy 150, Left
Rt on Summersong Ln, Last house on left
Rease include road names and nunters, landmarks
Mooresville
Iredell
Norman
Crescent Lot 207
hclude phase/lot number
on Paradise Pennisula Rd,
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
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Replacing old wooden wall w new 130' and refreshing rip rap 100'
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, backfill, excavation, rip rap, retaining walls, etc.)
1020 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, back fill, excavation, rip rap, retaining walls, etc.)
230sgft
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunter of trees, for instance)
None - all disturbed area will be grassed back
Sketch:
ChrisKDWQPreliminary.pdf
Application Fee:
1MB
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

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:
Christopher Kowalczyk

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20202028
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
Please note that multiple forms may be necessary if there are more than two owners of the Property.
PROPERTY LEGAL DESCRIPTION:
LZTREET ADDRESS OF EXISi INC HOME or LATITUDE/LONGITUDE OF NEW CONSTRUCTION:
7 5 timmef-soi, e-
ear-xStii74 itt c2 / 7
Parcel ID: 4 (Cal (0415 Sk.
Property Owner Name(s) - please print:
Property Owner: ehrisiofiket- S 14- oi‘,./e7k
Pro Dery Owner: <51-evie 13 T3e-fi
The undersigned, registered property owners of the above noted property, do herebyauthorize
:t•Aidti\
sCA'arardcwrikplt
Cp",5-AyLibr‘
amc 1alnwar1Y)
te act on my behalf and take ail action necessary for !tio orocessina, issuance and acceptance of
permit or certification and any and ali standard and special conditions attached.
Property Owners Mailing Address (it different than property address above):
Property Owner(s) 'Telephone: - 7 .35 q
IS
We hereby certify that the above information .subinitted in this application is true and accurate to the
of ow knowledoe.
Atithoriyett Author Ligt4attire.
Date
.3 I-1 )2,02A

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 02-2017
Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b_ Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc_
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake
(At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Level
Shoreline
FORM: SSGP 02-2017
Page 1 of 3

Lake
{At Vila Pond: Normal water Level)
Full Pond/ Normal Water Level
2 It.x 150 ft.
additional Bearing
if necessary,
Plan View
Existing Dock
30 ft K7rt
3ha150ft
Below full Pond/ N WL
PAWfrWEsu€t
Above 4utl gond/ NIML
FORM: SSGP 02-2017
Page 2 of 3

1

12/28/2O2O
ConnectGlS Feature Report
•CON NECTGIS
+�8 N�.ST� 1Q
Iredel[ County J
lredell
Printed December 28, 2020
See Below for Disclaimer
1 : 120 Feet
e maps prepared for this website are generated from recorded deeds, plats, and other public records. Users of these maps are hereby notified that the information
• rovided herein should be verified. lredell County assumes no legal responsibilities for any of the information contained on this site. Users are advised that the use of
ny of this information is at their own risk. All maps on this site were prepared using a 1000Se' Grid based upon the North Carolina State Plane Coordinate System from
• e 1983 North American Datum. The delinquent real property tax overlay is updated monthly. The information presented is not intended to be used or relied upon a
icial notice of tax liens, For additional information r• . ardin. delin • uent taxes, contact the Iredell Coon Tax Collector's Office.
https:lrlredell.connectgis.com/DownloadFile.ashx?i=_ags_map8525ba7debaf40d3943e4ab3d6e5f869x_htm&t=print 1/1

LOT 201
1 M16-262
29.21
94.96
12-00
24.25
72.23
40T 206 TO LOT 207
!a2 10.9-3990 10.21
223 531.2611 22.04
LOT 207
904 6R7-20M 51.66
706 686-111 61.92
!40 1464-261 11.60
307 N64-SLY 16.26
lee u06-21N 31.90
!09 N10-309 45.10
910 N91-61M 20.2E
]11 1/22-109 14.67
LOT 201
!l2 004.662 67.31
313 126-112 60.40
11/ N46-442 61.66
3E6 1146-136 72.55
911 119t-202 60.96
]1T 666-321 70.30
!1) 401 201
.12 664-40E 59.01
312 270-462 01.01
!Y0 1171-64E 51.02
!31 164-I2E 40.52
LOT 211
322 407-192
!2! N21-46H
324 M34-621
222 1115,61E
LOT 212
326 ▪ N71-642 61.91
227 1170.96! 60.41
129 669-496 64.23
320 H47-224 20.76
LOT 119
9!0 N11-31E 16.00
991 1102-16E 24.02
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99 2 N36-692 500
• ass -tar • 12.71
LOT 214
224 666-061
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19.00
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102 911-904
169 642-6114
114 626-671
122 140-15M
407 112
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199 616-612
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ROAD RI0NT OF MAT. 10 FEET FROM CORTIA
ELEV9TIOM 740, u.6.0.0. 6E0 LEVEL GAIN
RHO l0 FEET FROM 430[ LOT LIME.
ALL STREET COAXER 22011 ARE fO FEET.
PROPERTY LINE DISTANCES PRE COMPUTED TO
f01HT OF IHTEROECTION 01 OTREET CURREN'.
PR0FE9TT LINES 3MOMM 1.181CN FORM THE EDGE
OF LAKE NORMAN FOLLOWS CONTOUR EIi5RTTp11
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SCALE 1" = 100' RPAI:. !, f6',p
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12/28/2020
Property Data
Pia Data YY f}!3
-';j.i"I34 A[e�PllhF:r• 462:2 95031 0O0
"�•.,�tir'.; r).3tE 17:2P 2o2o
Disclaimer: While every effort is made to keep information provided over the Internet accurate and up-to-date, the County does not certify
the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping data
herein, or for their use or interpretation by the User.
r+'
209.
Gti
19;i
/001004)
Tax Account Number: 80076936
Old Parcel Number 17o2L0b000A2o7
Owner Name: KOWALCZYK CHRISTOPHER S+STEVIE BELL
Mailing Address: 117 SUMMERSONG LN MOORESVILLE NC 28117
Property Location: SUMMERSONG LN
Lot Number: 207
Legal Description: CRESCENT LAND+TIMBER CORP 510 PB15-20
Muri?LE. -psi xi5'firrnz,v,gon
Township Code: 17
City Code: 00
Neighborhood Code: 17228
vale for : tsoo - Current Year Property Record Card (PRC)
Building Value: 224340
Other Building Features: 2120
Land Value: 385000
web3. mobile311. comll redellRepori/report.aspx? P IIV=4627695081.000
1/2

ID#*
Regional Office*
Reviewer List*
20202028
Version *
1
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 12/28/2020
Contact Name * Gene Reneger
Contact Email Address* [e-mail]
Project Name * Kowalczyk Wall
Project Owner* Chris Kowalczyk
Project County* Iredell
Owner Address: Street Address
117 Summersong LN
Address Line 2
flry State / Province / Edon
Mooresville NC
Festal / Zip Code Country
28117 United States
Is this a transportation project?* C Yes [: No
Type(s) of approval sought from the DWR:
r 401 Water Quality Certification - l-- 401 Water Quality Certification -
Regular Express
W individual Permit 1— Modification
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.*
Place rip rap on 100' of shoreline and build new wooden wall on the
other 130' of shoreline to prevent erosion
Please give a couple of dates you are available for a meeting.

12/30/2020
Please attach the documentation you would like to have the meeting about.
ChrisKDWQPreliminary_pdf 1 MB
pdf only
By digitally signing below, 1 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.
• 1 also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day dock 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
;fir rS katidc2,
Submittal Date 12/28/2020