20210674 Ver 1_Shoreline Stabilization_20210510

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
55.38KB
(46).pdf
Pre -fling Meeting or Request Date 4/1/2021
ID# 20210674
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 payment and requests for more information here.
Owner Information:
Name: *
Email: *
Phone Number:*
Mailing Address:*
April Bolick
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
1236 Buffalo Shoals Road
Address Line 2
City
Catawba
Fbstal / Zip Code
28609-8022
State / Bovine / Region
NC
Country
US

Is there an agent working on the
project? *
Agent/Consultant Information
.......................................................................................................
Name:*
Company Affiliation: *
Email:*
• Yes
✓ No
Mickey Larson
LKN Permits LLC
lknpermits @gmail. c om
Phone Number:* [phone]
(x)m-
Mailing Address:* Street Address
109 Kase Court
Address Line 2
City State / Bovine / Region
Mooresville NC
Fbstal / Zip Code Country
28117-8019 US
Asigned and dated copy of the Agent Authorization letter:*
Agent (2).pdf 555.35KB
April Bolick Buffer Notification Form (1).pdf 949.23KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Bolick River Oak Landings
If your project has a formal name please use this. If your project does not haw 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
✓ Look up address
Upload Map: vicinity.pdf 321.73KB
Plat Bolick.pdf 948.54KB
Latitude:*
35.720610
Longitude:* -81.064255
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*
drawing.pdf 118.95 KB
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.)*
Pictures.pdf 2.61MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Statesville
County:* Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: * River Oak Landings, lot 48, 110 Johnboat Ct Statesville NC
hclude phase/lot nurrber
Directions to site:*
from 8320 NC-150 Sherrills Ford NC, head Northwest, turn right onto
NC-150W, turn right onto Sherrills Ford Rd, continue on Lowrance Rd to
Catawba, turn right onto Lowrance Rd, continue straight onto Rosewald
School St, follow S Main St and US-70 E to Bluewater Dr in Shiloh, turn
right onto 2nd Ave SW, turn left onto S Main St, turn right onto US-70 E,
continue on Bluewater Dr Drive to Johnboat Ct, rutn left onto Bluewater
Dr, turn right onto Portside Dr, turn left onto Johnboat Ct.
Rease include road nacres and nurrbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
residential, undeveloped, lot (39,46,47,48) is combined into lot 48
Residential, undeveloped, etc.
6. Property Size
3.281
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
rip rap to follow the shoreline contour
8. How will the work be done?*
rJ From Land
rJ 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.)
400
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.)
400
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)
no tree removal
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
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:
Mickey Larson

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210674
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. PLAN NO.
Please print:
Property Owner:
Property Owner.
PARCEL ID:
The undersigned, registered property owners of the above noted property, do hereby authorize
Leg
(Contractor / Agent)
(Name of suiting firm)
to act on my behalf and take ail actions necessary for the processing, issuance and acce t
this permit or certification and any and all standard and special conditions attached. p ance of
Property Owner's Address (if different than property above):
We hereby certify the above information submitted in th
best of our knowledge.
d Signature
Date:
t
is app
Iication is
orized Signature
rate: _
true ar
d accurate to the

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 110 Johnboat COtatesville NC 286i9 County: _Iredell
Owner: April Bohck
Print
Contractor/agent: Mickey Larson
Print
gnatur
Signature
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 pp1ication. 115A
NCAC 02H .0506 and 15A NCAC OAS .0243(8)1
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(5)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243
(6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically
approved by the Division. There are (imitation on size for decks. [15A NCAC 02B .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 0213 .0243(5), (6)]
Acknowledgement of Notification
i, April Bolick hereby state that ! 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 he buift within substantial compliance and intent of the 401 Water Quafity Certification and
Buffer Rules, the approved p a n(s) and specification(s),and other supporting materials.
Signature (owner):
Date: .�.R _

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DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210674
Version*
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 4/1/2021
Contact Name * Mickey Larson / LKN Permits LLC
Contact Email Address* [e-mail]
Project Name * Bolick Johnboat Lane
Project Owner* April R Bolick
Project County* Iredell
Owner Address: Street Address
110 Johnboat Lane
Address Line 2
City State / Rovince / Region
Statesville North Carolina
Fbstal / Zip Code Country
28609 United States
Is this a transportation project?* r 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
rJ 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?
Please give a brief project description below and include location information.*
stabilize 400 ft following the shoreline contour
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 4/1/2021