20211096 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:
DWR Pre -Filing Meeting Request Form
49.22KB
(3).pdf
Pre -fling Meeting or Request Date 5/26/2021
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 er ail address for payment and requests for more infornation here.
Owner Information:
Name:' Spain Trust (Jeff Spain Trustee)
* ef£s am440 ail com
Email: j p � @�
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
2213 Maritime Way
Address Line 2
City
State / Rovince / Fbgion
Denver
NC
Fbstal / Zip Code
Country
28037-9126
US

Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name: * Donna P. Hrko
Company Affiliation:* Lancaster Custom Dock and Lift Systems, Inc.
Email:* donna. lancasterdocks@gmaiL corn
Phone Number:* [phone]
(XXX)XXX-XXXX
Address:* Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
North Carolina
Fbstal / Zip Code
Country
28166
United States
Asigned and dated copy of the Agent Authorization letter:*
Spain Shoreline Agent Auth Form.pdf 149.89KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Spain Trust Shoreline Refresh
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 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
r Lookup address
Property Address Lookup:*
Latitude:* 35.475581
Street Address
2529 Ranger Island Road
Address Line 2
city
Denver
Fbstal / Zip Code
28037-8672
State / Province / Pegion
NC
Country
US
Longitude:*-80.959032
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*
Spain Shoreline Site Plan and Layout.pdf 1.27MB
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.)*
Spain Shoreline Photos.pdf 622.51KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Denver
County:* Lincoln
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 2529 Ranger Island Road Denver, NC 28037
hclude phasellot number
Directions to site:*
From NC-!6, Right onto Optimist Club Road, Left onto Triangle Circle
Road, Proceed straight across NC-16 Bus onto Unity Church Road,
Continue straight on Unity Church Road, Right onto Ranger Island Road,
Property is on the right near the end of the road.
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. Prope rty Size .804 +/- Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Seawall and existing boat ramp base refresh for stabilization and under
wash out prevention with Class A and Class B Rip Rap.
8. How will the work be done? * I7 From Land
V 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.)
690 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.)
500 sf construction
corridor
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(number of trees, for instance)
NONE
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:
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');
a 1 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:* DonnaP. Hrko
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20211096
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

Submittal Information
ID# 20211096
Project Name: Spain Trust Shoreline Refresh
Is this a transportation project?
Non -DOT
App Received Date:
Contact Emails
[e-mail]
County (or Counties)
Lincoln
Version: 1
Application Type:
Buffer Authorization
Web Access URL: https://edocs.deq.nc.gov/Laserfiche/indexaspx?
db=WaterResources#id=1907539;view=browse
Public URL: https://edocs.deq.nc.gov/WaterResources/Browse.aspx?dbid=0&startid=1907539
Payment Information
Fee Received* r Yes
f No - Application withdrawn by Applicant
r No - On hold for more than 30 days - application returned
Date Fee 7/14/2021
Received:*
Select Reviewer:* Alan Johnson:eads\adjohnson1
Select Reviewing Office:*
Mooresville Regional Office - [phone]

Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:*
Is this a transportation project?*
Donna P. Hrko
donna. [e-mail]
Spain Trust (Jeffrey Spain Trustee)
Spain Shoreline Refresh
Lincoln
Street Address
2529 Ranger Island Road
Address Line 2
aty
Denver
Postal / Zip axle
28037
C Yes c: No
Type(s) of approval sought from the DWR:
F- 401 Water Quality Certification - F- 401 Water Quality Certification -
Regular Express
F- Individual Permit F- Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes c: No
State / Province / Pegion
NC
Country
USA
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information.*
Shoreline refresh for stabilization and erosion control.
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.
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 5/26/2021

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State of North Carolina
Department of Environment and Natural Resources
M
µ Division of Water Resources
Water Resources 1SA NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVIROMMENIAL QUALITY
FORM: SSGP 02-2017
Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. Ad 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 Leve
Shoreline
Plan View
Fu[i pond/ NorrnaI Water
' . 0%r0,- "ne
2 R- x 151! ft
additional clearing
' if necessary
La ke
(At Full Pond/ Normal Water Level)
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IAE Full vandlna 4 ML& LEI] Existing Dock
/30n%7k
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FORM: SSGP 02-2017 E AMP E
Plan View
Page 1 of 3

FORM: SSGP 02-2017 Page 2 of 2

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Narne/address: !SSG �r r`a " CE'�unty: ►r] Y]
,d _ NC 7
Owner: r
Print
Contractor/agent: --"3— �
Print
Signature
The approval is for the purpose and design described in your application. 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)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243
(6)]
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 02B .0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construct Eon
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be 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 02B .0243(5), (6)]
Acknowledgement of Notification
1, , hereby state that € have been informed of the Catawba
Riparian Buffer Rule. Any 6rk conducted in the buffer, not specifically stated in the application and approved
by the Division of Water Resources (DWR), is a violation and subiect 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 a roved plan(s) and specification(s), and other supporting
materials.
Signature (owner); Date: l _`V�

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO:
STREET ADDRESS:
2529 Ranger Island Road
Denver, NC 28037
Please print:
PLAN NO:
Pro )ertV Owner: Spain Trust Jeff Spain Trustee
Property Owner:
PARCEL ID: 4613-63-8711
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko
(Contrartor/Agent)
of Lancaster Custom Dock and Lift Systems, Inc.
(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):
2213 Maritime Way
Denver, NC 28037
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowle
9Au4Spaistee
ature Authorized Signature
Jef
Date 7/5/2021
Date