20211082 Ver 1_Shoreline Stabilization_20210714

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 viewthe form.
Attach documentation of Pre -Filing Meeting Request here:
Pre -Submittal Meeting Request Form.pdf 1.17MB
Pre -fling Meeting or Request Date 6/3/2021
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 * [e-mail]
Rease provide an email address for payrrent and requests for pure information here.
Owner Information:
Name: * John Gregory, Grandfather Homes
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
1111 Central Ave Suite 320
Address Line 2
City
State / Frovince / Region
Charlotte
NC
Fbstal / Zip Code
Country
28204
United States

Is there an agent working on the
project? *
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:*
Email:
Phone Number:*
Mailing Address:*
F Yes
f^ No
Janice Estep
CBC Stone & Recycling, LLC
[e-mail]
[phone]
(XXX)XXX-XXXX
Address
638 Oakridge Farm Hwy
Address Line 2
City
Mooresville
Fbstal / Zip Code
28115
Asigned and dated copyof the Agent Authorization letter:*
Auth. Form.pdf 581.77KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Gregory Shoreline
State / Province / Fbgion
NC
Country
United States
If your project has a formal name please use this. If your project does not hake a formal name, please identify your project by
the owner name and proposed acti\ity (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
r Lookup address
Upload Map: Plat.pdf
Vicinity Maps.pdf
Directions.pdf
Latitude:* 35.541085
1.07MB
7.27MB
728.66KB
Longitude:*-80.884921
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 1.16MB
Buffer Form.pdf 1.01MB
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.)*
Shoreline Pics.pdf 15.26MB
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: * 129 Potomac Ln. Mooresville, NC 28117 Lot 2 The Preserve at Windsor
Pointe
Include phase&t nun ber
Directions to site:*
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
13 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 nunbers, landnaft etc.

5. Describe the existing land use or condition of the site at the time of this application:*
Lot cleared for new construction
Residential, undeveloped, etc.
6. Property Size 0.66 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 to replace existing wall on approx.
60' of shoreline on left side of property. Install an approx. 50' x 6' wide
enhanced boulder shoreline with approved plantings on right side of
property.
8. How will the work be done? * r% 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.)
3' below (180 sf)
for wall, 0' below
on enhanced
shoreline (50' x 6' _
300sf)
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 (60 sf) for
wall, 0' above on
enhanced shoreline
(50' x 6' wide =
300 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:*
(nunber 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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
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.
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");

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');
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
process?*
Project Number:* 20211082
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

Contact Name *
Contact Email Address*
Project Owner*
Project Name *
Project County*
Owner Address:*
Is this a transportation project?*
Janice Estep
[e-mail]
John Gregory, Grandfather Homes
Gregory Shoreline
Iredell
Street Address
129 Potomac Ln. Lot 2
Address Une 2
Oty
Mooresville
Fbstal / Zip Code
28117
r Yes r No
Type(s) of approval sought from the DWR:
r- 401 Water Quality Certification - r- 401 Water Quality Certification -
Regular Express
Individual Permit Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
r Yes r No
State / Ravine I Rion
NC
country
United States
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 cap on 60' of shoreline to replace
eAsting wall and install a 50' enhanced boulder shoreline with
approved plantings and river rock in between boulders
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.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• 1 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.

'Signaturew
Submittal Date 6/3/2021

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Project Name/address-Al—q v tr_ �a7 _County,
Owner: r, rlil Id I al 1.1-C /) / )J a _­�
Print
Contractor/agent, J
Signature
re
The approval is for the purpose and design described in your appl'i-F-ation. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A NCAC
02H .0506 and 15A NCAC 02B.0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer 'within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be removed.
Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B.0243(6)1
IN I
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division- There are limitation on size for decks. [15A NCAC 07B .0243(4) and (6))
11,11QN&
UC I M�ILWCU. --iLdging, spon, construction
material must be outside the buffer. [15A NCAC 02H.0502 and 15A NCAC 02B.0243 (4), (6), (8)3
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must he at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 028 .0243(5), (6)1
M
eCA-
6nr_,,, hereby -state that I have been informed of the Catawba
Riparian Buff r R le. , ny work conducted in the buffer, not specifically stated in the application and approved
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner): JL_JI �7?1 Date: _42�

Lake
(At Full Pond/ Normal Water Level)
3+ 6etc w .X uoI
Full Pond/
Normal .iiT�iii7 rr�
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Please approximately sketch the following information on this plan, length of shoreline
(Provide dimensions for each item, such as 10 ftx 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

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PROPERTY LEGAL DESCRIPTION:
LOT NO --a-- PLAN NO, PARCELID:
STREET ADDRESS:
A
Tile undersigned, registered property owners of the above noted property, do hereby authorize
J'9� �Cle of
(Contractor
this permit or certification and any and all standard and special conditions attached,
to act on my behalf and take all actions necessary for the processing, issuance and acceptanceof
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge,
A o gad Signature —1 Authorized Signature
Date: Date: