20210615 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:
DWR Pre -Filing Meeting Request Form.pdf 51.05KB
Pre -fling Meeting or Request Date 3/24/2021
ID# 20210615
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.
Annie Agresta
annie [e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
156 Gage Drive
Address Line 2
CitY
Mooresville
Rbstal / Zip Code
28115-5815
State / Rovince / Region
NC
Country
US

Is there an agent working on the
project?*
Agent/Consultant Information
Name:*
Company Affiliation:*
Email: *
rr Yes
r No
Dean Fisher
Lake Norman Custom Dock & Pile Driving, Inc
[e-mail]
Phone Number:* [phone]
(x)m-
Mailing Address:*
Street Address
PO Box 1439
Address Line 2
at/ State / Ftovince / Region
Denver NC
Fbstal / Zip Code Country
28037 USA
Asigned and dated copy of the Agent Authorization letter:*
Agent form.pdf 18.15KB
Catawba Rip Formfixed.pdf 3.18MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Agresta Shoreline
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 haee 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
C Look up address
Upload Map: 230 Allendale Cir - Google Maps.pdf 389.66KB
Latitude:*
35.630102
Longitude:* -80.930815
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*
plot plan.pdf
Drawing.pdf
Please use the diagram at the link below:
97.14KB
13.15KB
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.)*
image (3).pdf 23.5MB
image.pdf 8.68MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Troutman
County:* Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: * 230 Allendale Cir Troutman NC 28166 / lot number 22
Include phase/lot nurrber
Directions to site:*
Take NC-150 E toward Mooresville. Turn left onto Perth Rd. Turn left
onto State Park Rd. Turn left onto Morrison Farm Rd. Slight right onto
Allendale Cir. Turn left to stay on Allendale Cir. Property is on the left.
Rease include road nacres and nurrbers, landrrarks 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
.5 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Grading, clearing and backfill along shoreline. Installation and grading of
approx 8x130ft along shoreline for Rip Rap with fabric.
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, backfill, excavation, rip rap, retaining walls, etc.)
780 sq ft
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward: *
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
1560 sq ft
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)
3 trees and natural area
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:
Dean Fisher
ce l

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210615
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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 22
PLAN NO. PARCEL ID: 4628-69-9817
STREET ADDRESS: 230 Allendale Cir, Troutman, NC 28166
Please print:
Property Owner: Annie Agresta
Property Owner: Dominic Agresta
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher , of Lake Norman Custom Dock & Pile Driving , Inc
(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 Owner's Address (if different than property above):
156 Gage Drive, Mooresville NC 28115
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
uthorized Sig
Date:
Authorized Signature
Date: c).3A3 J7,[

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Agresta shoreline / 230 Allendale Cir, Troutman NC 28166
Project Name/address:
Owner: Annie Agresta
or,
Print Signature
Contractor/agent: Dean Fisher Z7eC �aa: .
Print Signature
County: I redell
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. [15A NCAC
02H .0506 and 15A NCAC 02B .0243(8)]
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(6)]
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 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. 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 02B .0243(5), (6)]
Acknowledgement of Notification
1, Annie Agresta , hereby state that I 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 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 (owner
Date: 03/23/2021
State of North Carolina Environmental Quality Water Resources
512 N. Salisbury Street 1611 Mail Service Center Raleigh. NC 27699-1611
919.7079000

Go gle Maps 230 Allendale Cir
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1951
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Owng{s Associates
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Real Estate Firm
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Travel Adventures
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DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210615
Version*
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 3/22/2021
Contact Name * Annie Agresta
Contact Email Address* [e-mail]
Project Name* Agresta Shoreline
Project Owner* Annie Agresta
Project County* Iredell
Owner Address: Street Address
230 Allendale Cir
Address Line 2
City State / Rovince / Region
Troutman NC
Fbstal / Zip Code Country
28166 USA
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
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?
Alan Johnson
Please give a brief project description below and include location information.*
install Rip rap shoreline
Please give a couple of dates you are available for a meeting.
3/24/2021

3/25/2021
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 3/22/2021