20211155 Ver 1_Shoreline Stabilization_20210727

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:
BOYST DWR Pre -Filing Meeting Request
49.48KB
Form.pdf
Pre -fling Meeting or Request Date 6/14/2021
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:' Janet Boyst
Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
7659 Keistlers Store Road
Address Line 2
City
State / Rovince / Fbgion
Sherrills Ford
NC
Fbstal / Zip Code
Country
28673-9208
US

Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name:*
Randy Jordan
Company Affiliation:*
Lyfe Marine
Email:*
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Address:*
Street Address
19109 W. Catawba Ave.
Address Line 2
Suite 200
City
Cornelius
Fbstal / Zip Code
28031
Asigned and dated copy of the Agent Authorization letter:*
Agent Auth.pdf 150.91KB
Catawba Riparian.pdf 238.6KB
Riparian Buffer Form.pdf 1.35MB
Boyst Clc deck and steps plan.pdf 518.89KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
.....................................................................................................................................................
Project Name:* Boyst Shoreline Project
State / Province / Fbgion
NC
Country
United States
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 Lookup address
Property Address Lookup:*
Street Address
7659 Keistlers Store Road
Address Line 2
City
Sherri% Ford
Fbstal / Zip Code
28673-9208
State / Province / Pegion
NC
Country
US
Latitude:* 35.556632 Longitude:*-80.995236

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*
Boyst Diagram.pdf 136.87KB
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.)*
Boyst Shoreline Photos.pdf
1.51MB
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:* 7659 Keistlers Store Rd
Include phase/lot nunber
Directions to site:*
NC-16 Business N to right onto Will Proctor St. to right onto
Campground Rd. ---> Slanting Bridge Rd. to left onto Keistlers Store Rd.
7659 is on the left.
Rease include road narres and numbers, landrrnrks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Fbsidential, undeveloped, etc.
6. Pro pertySize .712
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Lyfe Marine to install additional Class "B" Rip Rap as needed on 36 LF of
shoreline: push down existing rip rap, install geo-tech fabric, install rip
rap, remove dead tree and debris in the water.
The homeowner is doing additional work on the shore as discussed with
Alan Johnson; all forms and documents pertaining to this work is
attached.
8. How will the work be done? * V 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.)
144
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.)
36
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)
Grassy yard w/ existing shoreline stabilization.
Sketch: Boyst Diagram.pdf 136.87KB
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');
0 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:* Randy Jordan
Signature:
1?a14d1,T0I b1014

Initial Review
Is this accepted into the review
process?*
Project Number:* 20211155
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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: R
LOT NO. PLAN NO. PARCEL ID:
STREET ADDRESS:
Please print;
Property Owner:1��
Property Owner;
The undersigned, registered property owners of the above noted property, do hereby authorize
of
(Contractor Agent) (Na a 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 Owner's Address (if different than property above):
Telephone:��� -��) C\\C�1 —
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
A orized Signature
bate:
Authorized Signature
Date:

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Prole ct Nameladdress-��
Owner: �'�� C -
Print
Contractor/agent:
Randy Jordan
County: _
re
Print 5l►frhfire
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
02h1 .0506 and 15A NCAC 028 .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 and 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 [and 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, construction
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 velocltles to the lake. [15A NCAC 02B .0243(5), (6)1
Acknowledgement of Notification
I, C— c hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Any work condo ed in the huffer, not specifically stated in the application and approved
by the Division of Water Resources jDWR), is a violation and subject to enforcement. Due diligence wlII 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 plans) and specification(s), and other supporting
materials. .�
L
Signature (owner): pate:
A& - rS--'zo' 1

712612021 BA 10-2013_Buffer Auth Form_final_3-18-15 completed.docx - Google Docs
DWR State of North Car
olina
Division of Water Resources Department of Environment and Natural Resources
Division of Water Resources
1SA NCAC 026.0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (111(c), .0607 le)(2) — Buffer Authorization
FORM. BA 10-2013
A. Applicant Riparian Buffer Authorization Form
information
I. Project Information
la. Name of project: Janet C Boyst Lake Property
lb. County: Catawba
1c. Nearest municipality: Sherrills Ford, NO
1d. Subdivision name: nla
10. Is the project located in any of North Carolina's
twenty coastal counties. If yes, answer 1f below, ❑ Yes
1f. Is the project located within a NC Division of Coastal
Management Area of Environmental Concern (AEC)? ❑ Yes
2• Owner Information
2a. Name on Recorded Deed: Janet C Boyst, John R Boyst
2b. Deed Book and Page No. 3178/1962
2c. Map Book and Page No. 181346
(include a copy of the recorded
map that indicates when the lot
was created]:
2d, Responsible Party nla
Wporations]:ddress., 7657 Keistlers Store Road
te, zip: SherrillsFord,NC28673ne no.: 336-918-0329: nla.address: [e-mail]
3. Applicant Information (if different from owner) same
3a. Applicant is; d Agent❑ Other, specify;
3b. Name:
3c. Business name
(if applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
4. AgentlConsultant Information (if applicable) nla
4a. Name:
4b. Business name
(if applicable):
4c. Street address:
4d. City, state, zip:
4e. Telephone no.:
4f. Fax no.:
4g. Email address:
FORM: BA 10-2013
XX No
XX No
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712612021 BA 10-2013_Buffer Auth Form_final_3-18-15 campleted.docx - Google Docs
B. Project Information and Prior Project History
I.
Property Identification
1a.
Property identification no. {tax PIN or parcel ID]:
460604634286
1b.
Site coordinates [in decimal degrees):
Latitude: 35,555917 Longitude;-80.995729
1c.
Property size:
.71 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
Lake Norman
2b.
Water Quality Classification of nearest receiving
WS-IV, B; GA
water:
2c.
River basin:
Catawba
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application:
Residential Lake Front properties
3b. Attach an e'/2 x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c, Attach an 8'% x 11 excerpt from the mast recent yerzrm
of the published County NRCS Soil Survey Map
depicting the project site
3d. List the total estimated linear feet of ali existing streams {intermittent and perennial} on the property; n/a
3e. Explain the purpose of the proposed project:
Create a deck on land adjacent to the existing dock
3f. Describe the overall project in detail, including the type of equipment to be used:
Create a 5' x 40' deck and add individuaf stepping stones going to the deck, No equipment needed.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the ❑Yes XX No ❑Unknown
Corps or State been requested or obtained for this property/ Comments:
project (including all prior phases) in the past?
4b. If yes, who delineated the jurisdictional areas?
Agency) Consultant Company:
Name (if known): Other:
4c. if yes, list the dates of the Corps jurisdictional determinations or State determinations and attach
documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for ❑ Yes XX No ❑ Unknown
this project (including all prior phases) in the past?
5b. if yes, explain and detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? Q Yes
6b. If yes, explain.
FORM: BA 1D-2013
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7/26/2021 BA 10-2013_BufFer Auth Form_final_3-18-15 completed.docx - Google Docs
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques.
2. Buffer Mitigation
2a. Will the project result in an impact within a protected riparian buffer that requires puffer ❑ Yes XXNo
mitigation?
2In. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation and
calculate the amount of mitigation required in the table below.
Zone Reason for impact Total impact Multiplier Required mitigation
Zone (square feet (square feet
1 3 (2 for
Zone Catawba)
2 1.5
Total buffer mitigation requl
2c. If buffer mitigation is required, is payment to a d Yes ❑ No
mitigation bank or NC EEP proposed?
2d. If yes, attach the acceptance letter from the mitigation bank or NC E E P'
.
2e. If no, then discuss what type of mitigation is proposed.
FORM: BA 10-2013
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7/26/2021 BA 10-2013_Bufier Auth Form_final_3-18-15 completed.dcox - Google Docs
C. Impact Justification and Mitigation, continued
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7/26/2021
BA 10-2013_Bufer Auth Form_final_3-18-15 completed.docx - Google Docs
E. Diffuse Flow Plan
All buffer impacts and high ground impacts require diffuse flow or other form of
stormwater treatment. Include a plan that fully documents how diffuse flow will be
maintained. If a Level Spreader is proposed, attach a Level Spreader Supplement Form.
If due to site constraints, a BMP other than a level spreader is proposed, please provide
a plan for stormwater treatment as outlined in Chapter 8 of the NC stormwater BMP
Manual and attach a BMP Supplement Form.
_Janet C Boyst
ApplicandAgent's Printed Name
❑ Diffuse flaw
d Other BMP
NIA
Applicant/Agent's Signature
(Agents signature is Yalld only if an authorization letter from the applicant Is provided.y
Send 3 complete sets of this form and accompanying documents to the following:
06/30/2
1
Forgovernmetat transportation projects .sent I or government tra►tsporrQtinn projects seat by
by Ftr:st Class Wait via the U.SPoslal Service.• delivery.ser•vice {UPS, FedEx, err.]:
NC DWR, Transportation Permitting Unit OR INC DWR, Transporta
1617 Mail Service Center 512 N. Salisbury Stre
Raleigh, NC 27699 - 1617 Raleigh, NC 27604
Far all other projects seat by First Class .gall For all other projects s
via the US Postal Serrice (UPS, FedEx, etc.};
Karen Higgins OR Karen Higgins
NCDWR-401 &Buffer Permitting Branch NCDWR-401 &Buf
1617 Mail Service Center 512 N. Salisbury Stre
Raleigh, NC 27699 - 1617 Raleigh, NC 27604
FORM: BA 10-2013
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E. Diffuse Flow Plan
Ali buffer impacts and high ground impacts require diffuse flow or other form of
stormwater treatment. Include a plan that fully documents how diffuse flow will be
maintained- if a Level Spreader is proposed, attach a Level Spreader Supplement Form.
If due to site constraints, a BM P other than a level spreader is proposed, please provide a
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BMP
Manual and attach a BMP Supplement Form.
❑ Diffuse flow
❑ Other BMP
F. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federallstatellocal) funds or the use ❑ Yes (d No
of public (federal/state) land? j
lb- If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State (North Yes ❑ No
Carolina) Environmental Policy Act (NEPAISEPA)?
1 c. If you answered "yes" to the above, has the document been finalized by the State ❑ Yes
Clearing House? (If so, attach a copy of the NEPA or SEPA final approval letter) ❑ No
Comments:
2. Violations
2a. Is the site in violation of DWR Wetland Rules (15A NCAC 02H .0500), Isolated Wetland ❑ Yes No
Rules (15A NCAC 02H .1300), DWR Surface Water or Wetland Standards, or Riparian
Buffer Rules (15A NCAC 028A200)?
2b. Is this an after -the -fact permit application?
❑ Yes
2c, If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
J(jo e4
Applicant/Agent's Print Name
-4
Applica it/Agent's Si
(Agents -signature is valid only if an autl'ivria.t le r
,�,
ature Date
from the applicant is provided.)
Send 3 complete sets of this farm and accompanying documents to the following -
for government transportation projects sent
byF7rs1 C"lwaMail vier the 13PostalService:
F'or government transportation projects sent by
NC DWR, Transportation Permitting Unit
1617
delivery. service (UPS, Fe&Fr, etc.);
OR NC DWR, Transportation Permitting Unit
Mail Service Center
Raleigh, NC 27699 - 1617
512 N. Salisbury Street
Raleigh, NC 27604
For all other projects sem by First Class Mail
por all other projects seat by delivery service
via the CIS Postal Service
Karen Higgins
(UPS, Pled&G etc).
NC DWR — 401 & Buffer Permitting Branch
Karen Higgins
OR NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center
Raleigh, NC 27699 - 1617
512 N. Salisbury Street
Raleigh, NC 27604
FORM. BA 10-2013
Page 4 of 4

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Contact Name* Kim Jordan
Contact Email Address* [e-mail]
Project Owner* Janet Boyst
Project Name*
Boyst Shoreline Project
Project County*
Catawba
Owner Address:*
Street Address
7659 Keistler Store Rd
Address Line 2
aty
Sherrills Ford
Postal / Zip axle
28673
Is this a transportation project?*
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
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 Class T" Rip Rap to existing rip rap shoreline @ approximately
36 lineal feet. Remove tree debris in the water @ shoreline.
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 6/14/2021

Lake
(At Full Pond/Norrnal Water Level)
FI
Norm
S
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
I 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 ❑r dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: 55GP 10-2013 Page 3 of 3

Lake
(At Full Pond/Norrnal Water Level)
FI
Norm
S
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
I 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 ❑r dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: 55GP 10-2013 Page 3 of 3