20070449 Ver 2_Shoreline Stabilization_20210623

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:
159AsburyCirPrelimDWQFinal.pdf 50.47KB
Pre -fling Meeting or Request Date 4/28/2021
ID# 20070449
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.
Final Four Holdings LLC/ Todd SEnff
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
16234 Sasanoa Drive
Address Line 2
CitY
Cornelius
Rbstal / Zip Code
28031-8740
State / Rovince / Region
NC
Country
US

Is there an agent working on the
project? *
Agent/Consultant Information
.......................................................................................................
Name:*
Company Affiliation: *
Email:*
Phone Number:*
Mailing Address:*
C' Yes
r No
Mandy Renegar
Renegar Construction LLC
[e-mail]
[phone]
(iootpoot-i000t
Street Address
6026 Hwy 150 E
Address Line 2
City State / Bovine/ Region
Denver NC
Fbstal / Zip Code Country
28037 US
Asigned and dated copy of the Agent Authorization letter:*
159AsburyAgentForm.pdf 250.73KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
159 Asbury Cir 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.*
r Upload File
C' Look up address
Property Address Lookup:*
Latitude:*
35.590586
Street Address
159 Asbury Circle
Address Line 2
City State / F1-ovince / Fbgion
Mooresville NC
Fbstal / Zip Code Country
28117-8977 US
Longitude:* -80.923496
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*
159AsburyDWQDrawing.pdf 738.75KB
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.)*
159Asburycirpdfl .pdf 4.34MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Mooresville
County:* Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 159 Asbury Circle 28117 Lot 81
hclude phase/lot nunther
Directions to site:*
See attached with sketch
Rease include road nairea and numbers, 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
.66 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Place Rip Rap along shoreline with Barge
8. How will the work be done? *
r From Land
fJ 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.)
324 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.)
81 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:*
(nunter of trees, for instance)
none
Sketch: 159AsburySketchInfo.pdf 1.41MB
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:
Todd Senff
roc/ 5 '

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20070449
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Version:* 2
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
Please note that multiple forms may be necessary if there are more than two owners of the property.
PROPERTY LEGAL DESCRIPTION:
STREET ADDRESS OF EXISTING HOME or LATITUDE/LONGITUDE OF NEW CONS I RUC. ION:
q �,� i*- C (t nr\co %uA Q- iU 6 ,; i [t
Parcel ID: 4 )- S 13 763 , 000
Property Owner Name(s) — please print:
Property Owner:
Property Owner:
«/t Vim( ��bidtk LAC.
The undersigned, registered property owners of the above noted property, do herebyauthorize
ri C c-L-r_/ , of 1C cam_ r- -
(cbntractor/Agent) J (N ��5
( me of company)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of thi!,
permit or certification and any and all standard and special conditions attached.
Property Owners Mailing Address (if different than property address above):
Property Owner(s) Telephone: 330 — (115 `' 1/ 3
We hereby certify that the above information submitted in this application is true and accurate to then
best of our knowledge,
4 AuorizT eQ Signature ,.
Aclthorized Signs
ate' )-1
Dat Date

Water Resources
ENVIRONMENTAL QUALI tY
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 ice
(At Full Pond/ Normal Water Level)
L f
[I r,• OOP
• s OP
Full Pond/ Nor 471.1 L( �` vzir 1 • •
,liarolassar •r
,t
Plan View
7
FORM: SSGP 02-2017
Page 1 of 3

Lake
Pond/.:Normal Water Level)
Fulf Pond/ Normal Water Level
2 ft.x 150 ft.
additional Bearing
• if necessary
Plan View
Lake
(At Full Pond/ Normal Water Lever
•wM•*•yam•i, imo•••41
mpoi
Riprap
Mara ;OA
Existing Dock
30f(x7ft
3 ft x 150ft
Below tall pond/ NWL
FORM: SSGP 02-2017
Page 2 of 3

Props rty Data ...
7.ce. i';l.lrnber: 4627850799.000
Inquiry Date: 4/27/2021
Disclaimer: While every effort is made to keep information provided over the internet accurate and up-to-date, the County does not certify
the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping data
herein, or for their use or interpretation by the User.
1
•
206
11
•
O kaf erlP:'t'}perty Info
Tax Account Number: 80076951
Old Parcel Number: 1702L04000A080
Owner Name: FINAL FINAL HOLDINGS LLC
Mailing Address: 16239 SASANOA DR CORNELIUS NC 28031
Property Location: ASBURY CIR
Lot Number: -mr i<
Legal Description: CRESCENT LAND+TIMBER CORP S9 PB14-99
Township Code: 17
City Code: 00
Neighborhood Code: 17084
Value =.°` ffrq a _ Current Year Property Record Card (PRC)
Building Value: Null
Other Building Features: Null
Land Value: Null
Tax Assessed Value: Null
Deferred: Null
L nt1 Information - Register of Deeds Online Search
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Iredell
Printed April 27, 2021
See Below for Disclaimer
: 120 Feet
'r
he maps prepared for this websFte are generated from recorded deeds, plats, and other public records_ Users of these maps are hereby notified that the information
• rovided herein should be verified. Iredell County assumes no legal responsibilities for any of the information contained on this site. Users are advised 1that the use any of this information is at their own risk. AEI maps on this site were prepared using a 10005€' Grid based upon the North Carolina State Plane Coordinate System from
he 1R83 North American Datum. The delinquent real property tax overlay is updated monthly. The information presented is not intended to be used or relied upon as
•fficial notice of tax liens. For additional information re•ardin• delinquent taxes, contact the Iredell Count Tax Collector's Office.

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LIP ding craps
A Mooresville, NC
g 159 Asbury Circle, Mooresville, NC 28117
A Mooresville, NC
21 min , 8.4 miles
Light traffic
Via Brawley School Rd, Beaten Path Rd
• Local roads
Head northwest on W McLelland Ave toward S Academy St
Turn left onto 5 Academy St
Turn right onto W Wilson Ave
4 Road name changes to Brawley School Rd
r> 5 Turn right onto Blume Rd
259 ft
?.3 mi
1.2 mi
mi
4.9 mi
6.
Turn left onto Beaten Path Rd 71
ry 7 Turn left to stay on Beaten Path Rd 1 2 mi
r 8. Bear right onto Asbury Circle 0
Arrive at Asbury Circle
The last intersection before your destination is Beaten Path Rd
.2 mi
B 159 Asbury Circle, Mooresville, NC 28117
These directions are subject to the Microsofte, Service Agreement and are for informational purposes only No guarantee is made regarding their completeness or accuracy.
Construction projects, traffic, or other events may cause actual conditions to differ from these results. Map and traffic data © 2021 TornTom.

DWR Pre-Fil ing Meeting Req u est Form
ID#*Ve rsion *
Re gional Office *
Re v ie we r List *
Contact Name *
Contact Email Addre ss *
Proje ct Name *
Proje ct Owne r *
Proje ct County *
Owne r Addre ss:
Is this a transportation proje ct?*
Type (s) of approv al sought from the DWR:
Doe s this proje ct hav e an e xisting proje ct ID#?*
Do you know the name of the staff me mbe r you would like to re que st a me e ting with?
Ple ase giv e a brie f proje ct de scription be low and include location information.*
20070449 1
Mooresville Regional Office - [phone]
Alan Johnson
Pre-Filing Me eting Reque st submitte d 4/27/2021
Gene Renegar
[e-mail]
159 Asbury Cir Shoreline
Final Four Holdings LLC
Iredell
City
Cornelius
State / Province / Region
NC
Postal / Zip Code
28031
Country
United States
Street Address
16239 Sasanoa Dr
Address Line 2
Yes No
401 Water Quality Certification -
Regular
401 Water Quality Certification -
Express
Individual Permit Modification
Shoreline Stabilization
Yes No
Alan Johnson
Project Address: 159 Asbury Cir Mooresville NC 28117 Lot 81
Want to put out Rip Rap to stop shoreline from erosion
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:

Signature
Submittal Date
· 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.
· I 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.
4/27/2021