20211020 Ver 1_Shoreline Stabilization_20210623

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water Quality Certification, 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:
Pre -Submittal Meeting Request Form.pdf 1.02MB
Pre -fling Meeting or Request Date 5/17/2021
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:*
john. gegory@grandfatherhomescorn
Rease provide an email address for payrrent and requests for pore information here.
John Gregory, Grandfather Homes
john. gegory@grandfatherhomescorn
[phone]
(xxx)xxx-xxxx
Street Address
1111 Central Ave Suite 320
Address Line 2
CitY
Charlotte
Rbstal / Zip Code
28204
State / Rovince / Region
NC
Country
United States

Is there an agent working on the
project? *
Agent/Consultant Information
.......................................................................................................
Name:*
Company Affiliation: *
Email:*
Phone Number:*
( Yes
f^ No
Janice Estep
CBC Stone & Recycling, LLC
[e-mail]
[phone]
(xxx)m-
Mailing Address:* Street Address
638 Oakridge Farm Hwy
Address Line 2
City State / Province/ Legion
Mooresville NC
Fbstal / Zip Code Country
28115 United States
Asigned and dated copy of the Agent Authorization letter:*
Auth. Form .pdf 580.77KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Gregory 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.*
✓ Upload File
✓ Look up address
Upload Map:
Latitude:*
Plat Map.pdf 1.02MB
Vicinity Maps.pdf 6.09MB
Directions.pdf 613.64KB
35.542150
Longitude:* -80.884426
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*
Site Plan.pdf
Buffer Form.pdf
Please use the diagram at the link below:
1.04MB
990.77KB
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.)*
Shoreline Pics.pdf I5.25MB
4. Location of the property (where work is to be conducted)
Nearest Town:*
County: *
Lake/ river/ ocean adjacent to
property:
Mooresville
Iredell
Norman
Subdivisions name or site address:* 132 Potomac Ln. Mooresville, NC 28117 Lot 6 The Preserve at Windsor
Pointe
Include phase/lot nurrber
Directions to site:*
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
20 s (197 ft)
Turn right onto E Center Ave
2 min (0.5 mi)
Turn left onto S Church St
1 min (0.4 mi)
Follow E Wilson Ave and US-21 S to Alcove Rd
9 min (3.7 mi)
Turn right onto E Wilson Ave
1.5 mi
Turn left onto US-21 S
2.2 mi
Use the left lane to continue on Williamson Rd
387 ft
Take Templeton Rd and Camino Real Rd to Potomac Ln
4 min (2.1 mi)
Turn left onto Alcove Rd
0.5 mi
Turn right onto Templeton Rd
0.9 mi
Turn left onto Camino Real Rd
0.7 mi
Turn right onto Potomac Ln
302 ft
Potomac Ln
North Carolina 28117
Rease include road nacres and nurrbers, landnerl6 etc.

5. Describe the existing land use or condition of the site at the time of this application:*
Lot cleared for new residential construction
Fssidential, undeveloped, etc.
6. Property Size
0.658 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Install a VA Fieldstone wall with cap for new shoreline stabilization
8. How will the work be done?*
I From Land
I— 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.)
4' below (496 sf)
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.)
1' above (124 sf)
10' x 50' access
corridor (500 sf
temp. impact)
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 buffer, no trees removed, minimal disturbance to buffer
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:*
Janice Estep

Signature:

Initial Review
Is this accepted into the review fr Yes a No
process?*
Project Number:* 20211020
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
f $570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. (...52 PLAN NO. PARCEL ID:
STREET ADDRESS: t TerkniCke Ln•
Please print:
Property Owner: :7);t1r1
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Tcunstce E5-\•e , of CBC Stbn e£ I cqchry) LLC.
(Contractor / Agent) (Name of consulting fi)m)
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):
(lit Ce-rral Aye, 5v•14-e. -3ao akarlo-Vie NC- 9,8a04
Telephone: 1oz4- qq(s- Lot-tci
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Date:
SignatT
Authorized Signature
Date:

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Follow E Wilson Ave and US-21 S to Alcove Rd
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Turn right onto Templeton Rd
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610 East Center Avenue, Mooresville, NC to Potomac Ln, Mooresville, NC 28117 - Google Maps

Full Pond/
Normal
Shor
Lake
(At Full Pond/Normal Water Level)
f helow ) lay
Water Level witir ma.0401410 eT '. • -`
eline 00.Zoo—
above X lay
Only small ,,ncli
IAL( 1Cyt l +rees or, cmrfe
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Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3
et -riffled
operlj
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3
et -riffled
operlj

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Na :\��?.., %\ -. /|L/NC d39117County e\|
�
�Owner:�'A Y1
Print~^ � .
Contractor/agent: mage��
mt�8C &6ne i
Print
The approval bfor the purpose and design described 7nyour app|//-n /m���i�k�dint�
appUcadon�avkdadonofthe8uf�'rKu|e.l�especificworkshouldbe-provided --intheapp|ication [15ANCAC
O2H.OS86and1SANCACO2B.U243(QU '
Trees are not allowed tobcremoved from Zone lOfthe Buffer (within 38ftnfthe full pond ehevadon) unless
approved. Exception, those trees that are severely undermined along the imnnediateshoreline can be/e'nved
K8|nima/shaping and sloping along the imnned/ateshoreline isallowed. [15ANCACO2B.0243(6)] removed.
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B.D243 (6))
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. There are ((nO/t8tiQO on size for decks. 115A NCA[U2B .0243/4\ and (6)l
Work to be conducted from !and must indicate an access and indicate any trees that are to be removed,The
vxorkcorridor shouNbedescribed. The approved access corridor shall herestored. Sta0ingspoilconstruction
material must beoutside the buffer. [l5ANCACO2H.OSO2and 1SAN[A[UZ8.0243(4),(6~(R)] '
Stnrnnvvater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural e|evatibn and discharged prior to entering the buffer directed as diffuse or
sheet flow atnon-erosive velocities tmthe lake. [l6AN[A[UJB.0243(S)'(6)]
Acknowledgement Of Notification
-T—
.' mvl hereby state that ihave been informed nfthe Catavvba
RipahanBuffer Rule. �nw��nw�'�nductedinthe buffe�not specificaUystated inthe application and approved
bytheDk/isionofVVaterKesou--es(DVVR)'isavio|otionandsubiecttoenforoemnant.DuediUgencevvi|/be
taken such that the construction will bebuilt within substantial compliance and intent pfthe 401Water
Quality Certification and Buffer Rules, the approved pian(s) and specification (s), and other supporting
materials.
Signature (owner):
Date: J

I
I
I

DWR Pre -Filing Meeting Request Form
Contact Name *
Contact Email Address*
Project Owner*
Project Name*
Project County*
Janice Estep
[e-mail]
John Gregory, Grandfather Homes
Gregory Shoreline
Iredell
Owner Address:* Street Address
132 Potomac Ln
Address Line 2
atY State / Rovince / Region
Mooresville NC
Postal / Zip Code aunty
28117 United States
Is this a transportation project?* r Yes r No
Type(s) of approval sought from the DWR:
✓ 401 Water Quality Certification - r 401 Water Quality Certification -
Regular Express
✓ Individual Permit l Modification
17 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 a VA Fieldstone wall with TN Crab Orchard Cap. Remove small,
undermined trees on immediate shoreline in order to properly
stabilize.
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.
• 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.

Signature*
Submittal Date
eyrute?edid'E-02
5/17/2021