20191087 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:
8989AzaleaPrelimDWQFinal.pdf 50.37KB
Pre -fling Meeting or Request Date 5/4/2021
ID# 20191087
I. Applicant Information [15A NCAC 02H .0502(a)]
Version 2
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:*
mandyrenegarrealestate@gmail. com
Rease provide an email address for payrrent and requests for pore information here.
Azalea Retreat LLC
todd@lakecations. com
[phone]
(xxx)xxx-xxxx
Street Address
19701 Bethel Church Rd STE 103
Address Line 2
CitY
Cornelius
Rbstal / Zip Code
28031
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
Mandy REnegar
Renegar Construction LLC
[e-mail]
Phone Number:* [phone]
(m) -
Mailing Address:*
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:*
8989AzaleaAgentForm.pdf 247KB
8989Aza1eaAgentRevisedForm.pdf 251.43KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Azalea 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
F Look up address
Property Address Lookup:*
Latitude:*
35.638244
Street Address
8989 Azalea Rd
Address Line 2
City State / Bovine / Region
Sherrills Ford NC
Fbstal / Zip Code Country
28673 US
Longitude:* -80.954319
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*
8989Aza1eaDWQDrawing (2).pdf 660.74KB

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.)*
8989AzaleaPicsScanned.pdf 2.O1MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Sherrills Ford
County:* Catawba
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 8989 Azalea RD Lot 67
Include phase/lot nurrber
Directions to site:*
See attached with sketch attachment
Rease include road nacres and numbers, landmarks 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
.760 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 to prevent erosion
8. How will the work be done?*
17 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.)
1404 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, back fill, excavation, rip rap, retaining walls, etc.)
351 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)
none
Sketch: 8989SketchinfoDWQRevised.pdf 1.29MB
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

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20191087
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 UTHORIZATION 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 CONSTRULl1ON:
3C1 gel f)qie
Parcel ID: 4/6M4qg , 3
Property Owner Name(s) - please print:
Property Owner:
Property Owner:
z ie=o, e4-t_P6 G
The undersigned, registered property owners of the above noted property, do herebyauthorize
/LkL of j-,
(Co ctor/ gent)
� � f �ln � tip'- �_ �t� `� 1 �+��
J (NamA of company)
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 Mailing Address (if different than property address above):
7 (7 l 1 .--VV. e L vA rd. [`1 STET j
6; f, s •-)C g0 ,/ 1
Property Owner(s) Telephone:
We hereby certify that the above information submitted in this application is true and accurate to the
best of our knowledge.
Auhorize
Date

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 CONSTRUL PION:
gq
rWv-' i 5 I J C
Parcel ID: 96/9 6 L{ l 3 cr? 3
Property Owner Name(s) -- please print:
Property Owner:
Property Owner:
Y1013
The undersigned, registered property owners of the above noted property, do herebyauthorize
(Co actor/tent) (Nam of company)
to act an 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):
� C1 -1 e c-tAu rj, 11 STET irk
( (.0 s NC g03(
Property Owner(s) Telephone: 3 5 0- I - Ms _! 73 .3
We hereby certify that the above information submitted in this application is true and accurate to the
best of our knowledge.
.�'4),
AufYor'izedSi nature
9
Qf1(4J2\
Date

Water Resources
ENVIRONMENTAL GUA'_I Y
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
Lake
(At Full Pond/ Normal Water Level)
Fill Pond/ Normal Water Level
Shoreline
Plan View
NMr
074
FORM: SSGP 02-2017
Page 1 of 3

Lake
(At Full Food/ Normal -Water Leveij
FuEI Pond/1��
/NorrmaaF Water Level
• MN
2 ft.x 150 ft.
additional clearing
' if necessary
Plan View
Existing Dock
30fix7ft
3ftt 25011
Below full pond/ NW L
4"" 4 ft �
4Rx15pR
Above ful! pond/ NWt
E
FORM: SSGP 02-2017
Page 2 of 3

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A Mooresville, NC
B 8989 Azalea Rd, Sherrills Ford, NC 28673
A Mooresville, NC
31 min , 15.9 miles
Light traffic
Via NC-150, Sherrills Ford Rd
• Local roads
1 Head northwest on W McLelland Ave toward 5 Academy St
Turn Ieft onto NC-150 / E Plaza Dr
2. Pass McDonald's on the left in 2.2 mi
r3 Turn right onto Sherrills Ford Rd
Turn right onto Mollys Backbone Rd
.9 mi
.1 mi
5. Bear right onto Azalea Rd
Arrive at Azalea Rd
6' The last intersection before your destination is Oakwood Circle
B 8989 Azalea Rd, Sherrills Ford, NC 28673
1
.0 mi
.3mi
7 mi
These directions are subject to the Microsoft® Service Agreement and are For informational purposes only. No guarantee is made regarding their cdmpleteness or accuracy.
Construction projects, traffic, or other events may cause actual conditions to differ from these results. Map and traffic data © 2021 TomTom.

catawba county Geospatial Real Estate Search
MAI HG. serree. Information Services
w
Parcel: 461904923923, 8989 AZALEA RD SHERRILLS FORD, 28673
Owners: AZALEA RETREAT LLC,
Owner Address: 19701 BETHEL CHURCH RD STE 103
Values - Building(s): $2,000, Land: $282,700, Total: $284,700
1 in=200ft
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
04/27/2021

DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20191087
Version*
2
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 4/27/2021
Contact Name * Gene Renegar
Contact Email Address* [e-mail]
Project Name* Azalea Shoreline
Project Owner* Azalea Retreat LLC
Project County* Catawba
Owner Address: Street Address
19701 Bethel Church Rd STE 103
Address Line 2
City State / Rovince / Region
Cornelius NC
Fbstal / Zip Code Country
28031 United States
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
l Individual Permit I— Modification
l 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.*
Project Address: 8989 Azalea Rd Sherrills Ford NC 28673
Want to put out Rip Rap along shoreline to stop 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:

• 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
rock/ S&
Submittal Date 4/27/2021