20210791 Ver 1_Shoreline Stabilization_20210525

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:
request .pdf 98.98KB
Pre -fling Meeting or Request Date 5/24/2021
ID# 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 *
Owner Information:
Name:*
Email:
*
Phone Number:*
Mailing Address:*
[e-mail]
Rease provide an email address for payrrent and requests for pore information here.
Jeffrey W Kaylor / Kelli Kirby Kaylor
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
5405 NC HWY 16 N
Address Line 2
City
Claremont
Rbstal / Zip Code
28610
State / Rovince / Region
NC
Country
United States

Is there an agent working on the
project?*
r Yes
C: No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Kirby residence seawall repair
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.*
r Upload File
C: Look up address
Property Address Lookup:*
Latitude:*
35.812593
Street Address
6509 Eddleman Street
Address Line 2
City State / R-ovince / Region
Conover NC
Fbstal / Zip Code Country
28613-8769 US
Longitude:* -81.217265
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*
20210524 203318023_iOS.pdf 79.49KB
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.)*
lake 4.pdf 1.01MB
4. Location of the property (where work is to be conducted)
Nearest Town:* conover
County: * Catawba
Lake/ river/ ocean adjacent to Lake Hickory
property:
Subdivisions name or site address:* 6509 Eddleman ST, Conover, NC 28613
hclude phase/lot number
Directions to site:*
Hwy 16 to St peters Church road, Turn left onto Valwood Rd, Turn left
onto Curlee Rd„Turn left onto Eddleman St
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:*

Eroding behind existing seawall, residential
Fssidential, undeveloped, etc.
6. Property Size .98
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Not asking to change anything, just to add fabric behind wall so yard will
stop eroding under wall. Work will have to be done when lake is below
wall. To answer why #9 and 10 is .01, would not let me put a zero
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.)
2940
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.)
2940
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)
grass for 3-5 ft will be replanted as we go.
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:
Jeffrey W Kaylor

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210791
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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DWR # 21-0791
Inbox
Per May 4, 2021, 10:13
ez, AM
Dou
glas
J
Hey Sheri, It looks like the Kaylors wanted to fill out a Shoreline Stabilization application, as they are remediating a seawa
Montalvo, Sheri A <[e-mail]>
to Douglas, me, Alan
May 4, 2021,
10:16 AM
They can submit the shoreline. I will just add it in as additional info and make any changes in BIMS that I
need to and send them a fee request.
Thanks,
Sheri Montalvo
Administrative Specialist
401 & Buffer Permitting Branch
Division of Water Resources
Department of Environmental Quality