20210688 Ver 1_Shoreline Stabilization_20210504

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:
BLACK PREFILE.pdf 52.27KB
Pre -fling Meeting or Request Date 3/29/2021
ID# 20210688
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]
',lease provide an email address for payrrent and requests for pore information here.
Owner Information:
Name:*
Email:
*
Phone Number:*
Mailing Address:*
LKN VENTURES LLC
JBLACK@BLACKPEST. COM
[phone]
(xxx)xxx-xxxx
Street Address
190 Points End Drive
Address Line 2
CitY
Mooresville
Rbstal / Zip Code
28117-7303
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
Tamara hager
LKN DREDGE & MARINE CONSTRUCTION
HAGER@LAKEPERMIT. COM
[phone]
(x)m-
Mailing Address:* Street Address
PO BOX 5335
Address Line 2
C lty State / Province / Region
MOORESVILLE North Carolina
Fbstal / Zip Code Country
28117 United States
Asigned and dated copy of the Agent Authorization letter:*
black auth.pdf 1.2\IB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
LKN VENTURES LLC
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: black survey.pdf 1020.65KB
Latitude:*
35.495505
Longitude:* -80.940737
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*
black sketch.pdf 1015.39KB
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.)*
black pics.pdf 2.42MB

4. Location of the property (where work is to be conducted)
Nearest Town:* MOORESVILLE
County:* Iredell
Lake/ river/ ocean adjacent to NORMAN/CATAWBA
property:
Subdivisions name or site address:* CRESENT LAND & TIMBER LOT # 442
hclude phase/lot number
Directions to site:*
FROM MARSHALL STEAM STATION TURN LEFT ONTO HWY 150
FOR 5.4 MILES, TURN RIGHT ONTO MORRISON PLANTATION
PKWY FOR 1.1 MILES, TURN RIGHT ONTO BRAWLEY SCHOOL
RD FOR 8.0 MILES TO END OF BRAWLEY SCHOOL RD.
PROPERTY STRAIGT AHEAD.
Rease include road narres and nun hers, 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
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
8. How will the work be done?*
r From Land
V 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.)
0
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.)
0
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)
NONE
Sketch: black sketch.pdf 1015.39KB
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $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:
JON BLACK/ LKN VENTURES LLC
f9 Wet/ Llf, MO 1 LLC

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210688
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

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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. [2.5A NlC--
02H .0506 and 15A NCAC 0.)B .0, 3(8)!
Trees ere not 2llolived to be- removed from lane 1 of the Buffer (within30 ft of the full pond elevation), un€ess
approved. Exception., those trees that ere severely undermined along the imrnediate shoreline can be removed.
Mllinimel shaping and sloping clang the immediate shoreline is allowed. ; =5A NCAC 02B .0243(6)1
Benching, areding in the buffer is not 8Hawed_ Excessive disturbance of ground cover_ i15A NCACO28.02 3 (6)]
3e=lches, [rnpervious patios, impervious walkways, etc. 2re notcllowed in the busier unless specifically approved
by the Division_ There are limitation on si%e for docks. r?5A NCAC 0 B _0743(4) grid (6)]
Work. to be conducted from lend must indicate 2n 2CCCSS and indicate any trees tact ere to be removed. € he
work corridor should be dcscrfbed. The approved access corridor shall be restored. Steging, spoil, constructor:
material must be outside the buffer_ [15A. NCAC 02H .0502 cnd 25 :, NCAC 07B _0743 (4), (5), (d);
Storrnweter C2nnot be piped or channeled for direct discharge to the lake. All constructed or r; ,1J ar
discharges must be et the natural elev.tron end discharged prior to entering the buffer directed es dii: use or
she_t,"low et non --erosive velocities to the fake. [ 5A NCAC 0 B .0243(5), (6);
Acknowledge eni; of Notification
, hereby state that I hove been informed of the Catawba
•Ri ri - t11 e use. Any work conducted in the buffer, not specifically stated in the application and 'approve
by the Division of Water ReSOUrcas (DWR), is a violation and subject to enforcement. Due diligence 1nf1II be
t2i(en such th2t the construction l.Nlll 5e built within Substanti I compliance end intent of the 401 Water
Quality Ce s tific tion and Buffer Rules, the 2pprovei pier-1(s) end specif ication(s), end othersupportinc
(materiels_
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DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210688
Version*
1
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 3/29/2021
Contact Name * TAMARA HAGER
Contact Email Address* [e-mail]
Project Name* LKN VENTURES LLC
Project Owner* JON BLACK
Project County* Iredell
Owner Address: Street Address
194 POINTS END DR
Address Line 2
City State / Rovince / Region
MOORESVILLE NC
Fbstal / Zip Code Country
28117 US
Is this a transportation project?* C Yes ( No
Type(s) of approval sought from the DWR:
I— 401 Water Quality Certification - W 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?
NONE NEEDED
Please give a brief project description below and include location information.*
REFURBISH RIP RAP SHORELINE FOR STABLIZATION
Please give a couple of dates you are available for a meeting.

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 3/29/2021