20210525 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:
DWR Pre -Filing Meeting Request Form.pdf 51.65KB
Pre -fling Meeting or Request Date 3/8/2021
ID# 20210525
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 * [e-mail]
Rease provide an email address for payrrent and requests for pore information here.
Owner Information:
Name:*
Email:
*
Phone Number:*
Mailing Address:*
Daren Bergstein
mwetter@nesthomes. com
[phone]
(xxx)xxx-xxxx
Street Address
103 Steinbeck Way
Address Line 2
CitY
Mooresville
Rbstal / Zip Code
28117
State / Rovince / Region
NC
Country
United States

Is there an agent working on the
project? *
Agent/Consultant Information
..................................................................................................................
Name:*
Company Affiliation: *
Email:*
Phone Number:*
Mailing Address:*
C' Yes
r No
Michael Wetter
Nest Homes
[e-mail]
[phone]
( )m-
Street Address
PO BOX 3965
Address Line 2
City State / Province/ Region
Mooresville NC
Fbstal / Zip Code Country
28117 United States
Asigned and dated copy of the Agent Authorization letter:*
AAForm.pdf 28.41 KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Bergstein - Harbor Landing Lot 9
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:*
35.623691
Street Address
907 Cornelius Road
Address Line 2
City State / Frovince / Fbgion
Mooresville NC
Postal / Zip Code Country
28117 US
Longitude:* -80.884856
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*
SitePlan.pdf 223.64KB
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.)*
Berstein_Shoreline.pdf 1.17MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Mooresville
County:* Iredell
Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address:* Harbor Landing -
hclude phase/lot number
Directions to site:*
NC150 to Perth Rd - Right onto Perth - Right onto Cornelius Rd -
Property on right .75 miles
Rease include road naves and nurrbers, landrrarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
New home under construction - shoreline is grassed
Residential, undeveloped, etc.
6. Property Size .72
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Stabilization of shoreline using rip rap size natural boulders
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.)
888
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.)
444
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)
Natural grassed
Sketch: SitePlan.pdf 223.64KB
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

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:
J. Michael Wetter Jr.
c .:7-/W h itr7FFt 071.

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210525
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: LARDI d, PLAN NO: PARCEL ID:
STREET ADDRESS:
907 Cornelius Rd. Mooresville NC
Please print:
Property Owner: Darren Bergstein
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Michael Wetter , of Nest Homes
(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 Owners Address (if different than property above):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
i4 - _1444.4.i.....0
Authorized igi ature
z
Date
r
Authorized Signature
Date

12. 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
La ke
{At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Level
"!17:Arrir
2 ft. x 150 ft.
additional clearing
" if necessary
E
Plan View
Lake
(At Full Pond/ Normal Water Level)
Existing Dock
30Rx7ft
ovrot
6111
u
<AMPL
3 ft x150 ft
Below full pond/ NM_
m�
4ftx150k
Above full pond/ N W L
FORM: SSGP 02-2017
Page 3 of 4

Proposed Rip Rap
6 FT
La ke
(At Full Pond/ Normal Water Level)
Side View
0
-13
0
L
V
3 ft. below full pond water level
4 ft. above full pond water level
2 ft. additional ckearing
*if necessary
Existing bank
10 ft. bank
height
Side View
FORM: SSGP 02-2017 Page 4 of 4

12. 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
La ke
{At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Level
"!17:Arrir
2 ft. x 150 ft.
additional clearing
" if necessary
E
Plan View
Lake
(At Full Pond/ Normal Water Level)
Existing Dock
30Rx7ft
ovrot
6111
u
<AMPL
3 ft x150 ft
Below full pond/ NM_
m�
4ftx150k
Above full pond/ N W L
FORM: SSGP 02-2017
Page 3 of 4

Proposed Rip Rap
6 FT
La ke
(At Full Pond/ Normal Water Level)
Side View
0
-13
0
L
V
3 ft. below full pond water level
4 ft. above full pond water level
2 ft. additional ckearing
*if necessary
Existing bank
10 ft. bank
height
Side View
FORM: SSGP 02-2017 Page 4 of 4

DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210525
Version*
1
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 3/8/2021
Contact Name * Michael Wetter
Contact Email Address* [e-mail]
Project Name * Bergstein - Harbor Landing Lot 9
Project Owner* Nest Homes
Project County* Iredell
Owner Address: Street Address
PO BOX 3965
Address Line 2
City State / Rovince / Region
Mooresville NC
Fbstal / Zip Code Country
28117 United States
Is this a transportation project?* C Yes ( No
Type(s) of approval sought from the DWR:
I— 401 Water Quality Certification - I— 401 Water Quality Certification -
Reg ula r Express
I— Individual Permit I— 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 and include location information.*
Harbor Landing Lot 9
907 Cornelius Rd
Mooresville NC
Requesting to install rip rap along shoreline.

Please give a couple of dates you are available for a meeting.
3/9/2021
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.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• !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 3/8/2021