20210333 Ver 1_Shoreline Stabilization_20210514

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:
Yachtsman Pre Filing Request form.pdf 50.67KB
Pre -fling Meeting or Request Date 2/12/2021
ID#
20210333 Version
I. Applicant Information [15A NCAC 02H .0502(a)]
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: * Brian Rich (HOA President)
Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
13822 Queens Harbor Road
Address Line 2
CitY
Charlotte
Rbstal / Zip Code
28278
State / Rovince / Region
NC
Country
US

Is there an agent working on the
project?*
r Yes
C: No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Yachtsman
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.*
F Upload File
r Look up address
Upload Map: yachtsman mapping - gis.pdf 1.05MB
Latitude:* 35.120341
Longitude:* -81.031721
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*
Yachtsman application water level sketch.pdf 3 17.8KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/O/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.)*
Yachtsman shoreline pics.pdf 12.69MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Steele Creek
County: * Mecklenburg
Lake/ river/ ocean adjacent to Lake Wylie
property:
Subdivisions name or site address:* Yachtsman townhomes along shoreline @14055 Queens Harbor Rd.
hclude phase/lot nunber
Directions to site:*
Take Hwy 16 S toward charlotte 10 miles, Merge onto I485 outer loop 10
miles, take exit 4 NC -160 towards Fort Mill, .4 Miles, right lane towards
NC 160 s .5 miles, Turn R onto Shopton RD W .6 miles, @ traffic circle
stay straight on Shopton RD W 3.5 miles, make right onto pine harbor rd
.8 miles, right onto yachtsman harbor dr..1mile, turn right onto Queens
Harbor drive 450 ft destination on left.
Shoreline work along Queens Harbor RD. Construction entry @ 14055
Queens Harbor Rd.
Rease include road naves and nurrbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*

Residential multi family town homes
Fssidential, undeveloped, etc.
6. Property Size
Approx. 14 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Erosion repair, sidewalk failure/ replacement. install segmented retaining
wall
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.)
8,000 sqft
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.)
12,000 sqft
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)
grass and shrubs
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
• I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:*
Signature:
Virginia Macke]

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210333
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

Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed:5/13/2021 2:48:14 PM
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Water Resources
LNVIf2ONMENTAL QUALITY
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
La ke
(At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Levu
n ., per, .
Shoreline
Plan View
IMMI WIN
FORM: SSGP 02-2017
Page 1 of 3

15R-->
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La ke
(At Fall Pond/ Normal Water Levu)
1:'
Side View 44
w
a)
—J
Normal Wate
0
V)
c
0
EL,
Lake
IPI Fu I Pond/ Normal Water Level)
111104000111P IMP Al
Full Pond/ Normal Water Level Wl iZ e
—'1 MATIr " „..+ -
1104
OROMOONOW
ems`
2R.'150 ft.
additional clearing
• IF necessary
Plan View
Existing Dock
30ftx7ft
3 ft, 150ft
Below lull puud/ NWL
4ftx150ft
Above full pond! NWt
E
FORM: SSGP 02-2017 Page 2 of 3

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DWR Pre -Filing Meeting Request Form
NORTH CA:iOLINA
6nvlronmerrtol Quality
Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:*
Mark Davis
[e-mail]
Brian Rich (HOA President)
Yachtsman
Mecklenburg
Street Address
PO BOX 934
Address Line 2
City State / Rovince / Region
Denver NC
Fbstal / Zip Code Country
28037 United States
Is this a transportation project?* r Yes c: 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#?*
(' Yes c: 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.*
Segmented Retaining wall, rip rap refresh, replace existing sidewalk
Please give a couple of dates you are available for a meeting.
3/8/2021
3/9/2021
3/10/2021
Please attach the documentation you would like to have the meeting about.
Yachtsman project pictures.pdf 1.25MB
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 2/12/2021