20210733 Ver 1_Shoreline Stabilization_20210513

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:
Pre -Submittal Meeting Request Form.pdf 1.21 MB
Pre -fling Meeting or Request Date 4/10/2021
ID# 20210733
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.
Peter Diaz
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
620 Lakeview Shores Loop
Address Line 2
CitY
Mooresville
Rbstal / Zip Code
28117-6635
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 Hwy
Address Line 2
City State / Province/ Legion
Mooresville NC
Fbstal / Zip Code Country
28115 United States
Asigned and dated copy of the Agent Authorization letter:*
Auth. Form.pdf 531.68KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Diaz 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: Survey.pdf 1.12MB
Vicinity Maps.pdf 5.76MB
Directions.pdf 750.4KB
Latitude:*
35.573194
Longitude:* -80.949434
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:
1.1 MB
913.11KB
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 8.49MB
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:* 620 Lakeview Shores Loop Mooresville, NC 28117 Lot# 249 Crescent
Land & Timber Corp.
Include 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 NC-1100/Brawley School Rd to McKendree Rd
16 min (7.6 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
4.3 mi
Continue on McKendree Rd. Drive to Lakeview Shores Loop
5 min (2.3 mi)
Turn right onto McKendree Rd
1.6 mi
Turn right onto Lakeview Shores Loop
0.1 mi
Turn left onto Abbot Road
0.1 mi
Continue onto Lakeview Shores Loop
Destination will be on the right
0.4 mi
620 Lakeview Shores Loop
Mooresville, NC 28117
Rease include road nanes and nunbers, landnarks 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
0.707 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
At right of dock, install boulder rip rap at base of existing wood wall up
to 1' from top of wall
8. How will the work be done?*
r From Land
17 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 (441 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.)
0' above
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, no 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
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:
Janice Estep
r?2:•ref a° c ."¢a!at

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210733
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 AUTHORIZATIQN FORM
PROPERTY LEGAL DESCRIPTION;
LOTNOI at-t_� PLANNOI _ PARCEL ID:
STREI I ADDRESS:
Please print:
Pro.perty Owner:
Property Oviner:
The undersigned, registered property owners of the above noted property, do hereby authorize
C�
(Contractor / Agent)
(Name of consulting fir
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.
Froperty Owner's address (if different than property above):
Telephone:
0_1_7 ct t °mP 17 Co D._j.2j.7:
We hereby certify the above information submitted in ths application is true and accurate to the
best of our knowledge.
Authonzed Si natur
Date: 3 2, 112ew
Authorized Signature
Date:

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Please approximately sketch the following information on this plan, Iength of shoreline
(provide dimensions for each item, such as lOftx 100ft)*:
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 dill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining malls, 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. (CI edO
Owner:
Print
Contractor/agent: �
Print
ificorvikko County:
Signature
f.� re
The approval [ is far the
pp 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 cf she 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.
Minma shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243{6}]
Benching, grading in the buffer is not alfowed. 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 limitation 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. AH constructed storrnwater
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)]
Acftnow!edgement of Notificcition
76)
Et-k-e_A--- ia,e1 .._. , hereby state that I have been info.rmed 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)J 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 approved plan(s) and specification(s),and other supporting
materials.
Signature fawner;:

OE.
t
4
a.

0,1111
DWR Pre -Filing Meeting Request Form
ID#*
Regional Office
*
Reviewer List*
20210733
Version*
1
Mooresville Regional Office - (704) 6631699
Alan Johnson
Pre -Filing Meeting Request submitted 411012021
Contact Name*
Contact Email Address
*
Project Name
Project Owner*
Project County*
Owner Address:
Janice Estep
infocbcstoneandrecycIing .corn
Diaz Shoreline
Peter Diaz
Iredeid
Street Address
620 Lakeview Shore Loop
Address Line 2
aty State / Province # Region
Mooresvifle NC
Rbsial f Zip Code Country
28117 United States
Is this a transportation project?
* r Yes No
Type(s) of approval sought from the DWR:
r 401 Water Quality Certification - 401 Water Quality Certification
Regular Express
r Individual Permit r Modification
Shoreline Stabilization
Does this project have an existing project ID#?*
r Yes 6' No
Do you know the name of the staff member you would like to request a meeting with?
Alan Johnson
Pease give a brief project description below and include location information.
*
At right of dock, install boulder rip rap at base of existing wood wall up
to 1 from top of walk. Project by barge.
Please give a couple of dates you are available for a meeting.

4/12/2021
4/13/2021
4/14/2021
4/15/2021
4/16/2021
Please attach the documentation you would like to have the meeting about.
Diaz Shoreline.pdf
pcif only
2.45MB
By digitally signing below, I certify that I have read and understood that per the Federal Cean Water Act Section
401 Certification Rule the fotiowing statements:
This form completes the requirement of the Pre -filing Meeting request in the Clean Water Act Section 401 Certification
Rule.
understand by signing this dorm that I cannot submit my application until 30 calendar days after this prefihing
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 Iocation
and time if a meeting is necessary. You will receive notification when the thirtyday clack has expired, and you can submit an
application.
Signature
(3,recaoWeife
Submittal Date 4/10/2021