20210096 Ver 1_Shoreline Stabilization_20210603

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:
Jason Barclay DWR Pre -Filing Meeting
55.35KB
Request Form.pdf
Pre -fling Meeting or Request Date 6/8/2021
ID#
20210096 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 payment and requests for more information here.
Jason Barclay
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
15716 Eagleview Dr
Address Line 2
City
Charlotte
Rasta) / Zip Code
28278
State / F1 ovine / Region
nc
Country
Meek

Is there an agent working on the
project? *
Agent/Consultant Information
.......................................................................................................
Name:*
Company Affiliation: *
Email:*
Phone Number:*
Mailing Address:*
• Yes
✓ No
Wes Bradley
Draw Enterprises Inc
[e-mail]
[phone]
( )m-
Street Address
8100 Wilkinson Blvd ste 105
Address Line 2
City State / Rovince / Region
charlotte nc
Fbstal / Zip Code Country
28214 meck
Asigned and dated copy of the Agent Authorization letter:*
Jason Barclay authorization.pdf 361.56KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Barclay Property Shoreline Wall
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: Jason Barclay Vicinity.pdf 326.651 B
Latitude:*
35.069353
Longitude:* -81.054007
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*
Jason Barclay NCDWR Form.pdf 492.9KB
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.)*
Jason Barclay Pics.pdf

4. Location of the property (where work is to be conducted)
Nearest Town:* charlotte
County: * Mecklenburg
Lake/ river/ ocean adjacent to Lake Wylie
property:
Subdivisions name or site address:* Palisaides
hclude phase/lot number
Directions to site:*
Hwy 49 south, left onto Grand Palisaides Parkway, at second round
about, turn right onto Kalabash, turn rt onto Cozy Cove Rd, turn right
onto Burnt Hickory Dr , end of street on left
Rease include road names and nurrbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Vacant , wooded/open, future homesite
Residential, undeveloped, etc.
6. Property Size
1.7
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Property is currently severly eroded at shoreline with vertical and
undercut sections aprox 23' tall. No current shoreline protection is
present.
Propose to build a concrete block wall with rip rap scour protection to
both block wave action and allow a usable slope above 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.)
3780
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.)
10600
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)
small scrub trees, few 14" , brush
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):
G $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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:* Thomas Wesley Bradley
Signature:
7.--wik6Lxyfrf-APLXY

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20210096
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: q36
PLAN NO: 43 AZ5 -64,0 PARCEL ID:
STREET ADDRESS:
177040 -ouewr giutoki OQ
L'W�(fLtoi7� 1�C ziebz_
Please print:
Property Owner:-BAieLt..4
Property Owner: /27/6'../E4G /4,ec y
z i 7 i 14.3
The undersigned, registered property owners of the above noted property, do herebyauthorize
,of di
(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 Owners Address (if different than property above):
/S7/la EAGLt /Eli, 15,E/vim
077E ll/G Zce2711
Telephone: ‘74' y 5 77- 5 7 Z
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Date
orized Signature
6//ZaZ/
Authogfzed Signature
Date

Water Resources
ENVIRONMENTAL 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
Full Pond/ Normal Water
Shoreline
La ke
(At Full Pond/ Normal Water Level)
caia
i,41�! f �� h 2
owa a
j1 A
iteh-o' i `
gi ri7 r n/1 �L++�j W LE
(gL.rEc 6r•1 rLAQ
1
Za
5.pti
l °a\
Plan View
>f
FORM: SSGP 02-2017
Full Pond/ Normal Water Level
r r�
7hore7ne
2ft. A150 ft.
additional clearing
it necessary
Lake
{At Full Pond/ Normal Water Level)
Existing Dock
/30ftx7ft
3fc:150h
Below lull pond/ NWL
nft:1S0k
Above full pond/ NWL
E AMPliE
Plan View
Page 1 of 3

La ke
4z.
Za
/_r
fi
(44
(At Full Pond/ Normal Water Lee 9)„�
Se' co
v►w
L
0
z
0
z'/w
Side View
-,0
0
0
L
3 ft. below full pond water level 4 ft. above full pond water level
2 ft. additional clearing
*If necessary
10 ft. bank
height
Existing bank
•
4ir
#7'
$'AM
PLE
Side View �,r
FORM: SSGP 02-2017
Page 2 of 2

DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210096
Version*
1
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 1/14/2021
Contact Name*
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
Wes Bradley
[e-mail]
Burnt Hickory Improvements
Jason Barclay
Mecklenburg
Street Address
15716 Eagleview Dr
Address Line 2
City
charlotte
Fbstal / Zip Code
28278
Is this a transportation project?* C Yes ( No
Type(s) of approval sought from the DWR:
I— 401 Water Quality Certification -
Regular
I— Individual Permit
W Shoreline Stabilization
I— 401 Water Quality Certification -
Express
I— Modification
Does this project have an existing project ID#?*
C Yes ( No
State / Rovince / Region
nc
Country
meck
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.*
Vertical erosion on shoreline, no current protection, add retaining
wall, regrade vertical grade to include slope.
Please give a couple of dates you are available for a meeting.

1/19/2021
1/20/2021
1/21/2021
1/26/2021
1/27/2021
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
T
Submittal Date 1/14/2021