HomeMy WebLinkAbout20211366 Ver 1_Shoreline Stabilization_20210915Submission 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:
GINGERICH PRE FILE.pdf 49.51KB
Pre -fling Meeting or Request Date 8/10/2021
ID# Version 1
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 * HAGER@LAKEPERMIT.COM
Rease provide an email address for payment and requests for pure information here.
Owner Information:
Name: * DANIEL GINGERICH
Email: * SHERRYGINGERICH@GMAIL. COM
Phone Number:* (727)207-3834
(xxx)xxx-xxxx
Mailing Address:* Street Address
8112 Tadlock Trail
Address Line 2
City
State / Frovince / Region
Denver
NC
Fbstal / Zip Code
Country
28037-8692
US
Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name: * TAMARA HAGER
Company Affiliation:* LKN DREDGE & MARINE CONSTRUCTION
Email:* HAGER@LAKEPERMIT. COM
Phone Number:* (704)575-2227
(XXX)XXX-XXXX
Address:* Street Address
PO BOX 5335
Address Line 2
City
State / Province / Region
MOORESVILLE
North Carolina
Fbstal / Zip Code
Country
28117
United States
Asigned and dated copy of the Agent Authorization letter:*
GINGERICH AUTHpdf 390.66KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* GINGERICH
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
Upload Map: GINGERICHSURVEY.pdf 310.52KB
Latitude:* 35.469222 Longitude:*-80.973086
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*
GINGERICH SKETCHpdf 244.04KB
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.)*
GINGERICH PIC.pdf 56.49KB
4. Location of the property (where work is to be conducted)
Nearest Town:* DENVER
County:* Lincoln
Lake/ river/ ocean adjacent to NORMAN/CATAV;M
property:
Subdivisions name or site address:* CLARA LUCKEY ESTATE
hclude phasellot number
Directions to site:*
FROM COWANS FORD DAM TRAVEL WEST .50 MILES, TURN
RIGHT ONTO CLUB DR 4.3 MILES, MERGE ONTO HAGERS FERRY
RD 1.1 MILES, RIGHT ONTO N PILOT KNOB RD 390 FT., RIGHT
ONTO NC-16 BUSINESS 1.6 MILES, RIGHT UNITY CHURCH RD .20
MILES, RIGHT ON GRAHAM RD 2.5 MILES,RIGHT ON CAPTAINS
WAY .70 MILES, RIGHT MALLARD RD 72 FT, PROPERTY ON LEFT
ONTO TADLOCK TRAIL.
Rease include road naves 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 .78
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
RIP RAP SHORELINE FOR STABILIZATION
8. How will the work be done?* r From Land
V From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
0
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.)
0
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 BY BARGE
Sketch: GINGERICH SKETCH pdf 244.04KB
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:' DANIEL GINGERICH
Signature:
Submittal Date: 9/13/2021
Initial Review
Is this accepted into the review
process?*
Project Number:* 20211366
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - (704) 663-1699
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00
ATAN IA RIPARIAN, SUPERB NOWRCAMI GH FEDRIVi
Project N-amejadrtre r �
e, lm�i� t rc A-- i n.� L ru
Wntm
The approval IS for lire purpose and design described in your zpplication. kni psets not, indicated in the
2PPIic2tIon is a Violation ofthe Bi.Eit'er Rule. 5itespeci7I[: wori4 snood be provided in the application. ( i5rt-`. NC;~C
02H _0545 and "! 5R N CAC 07 B _02 ^3(8 )
TEE M not BiIOwsd to be removal iron ns 1 of be SUM, (wiihir►30 ft Qi thefull pond elevarion), u l)as=
@PprOV3d_ Encalltior.. thasetrF-e5 the, are severely undermined alonsi i4e it7' mechaate shoreline car, be rem, oved.
l�1liriii' al 5ftping arld toplilg '2i€ n %he in,nmediBic shoreline is alloivad. 115:: WCAC 028 _0243(5)1
Oanc tng, �T?C Eilw EiE � c r�i icT ES ilC3�cEkQL�l�n_ StiI� d[.sbbUrbance QZ _round cover. CISA MCAC0ZB _02 3 (C)I
3P-eCrhas; im-pGr ijila C pataq iilpentE{7sJb wOkwatf5, etc are not allowad in the buffer, UiIEessspc-cllilcall[- appr otted
O ha E]NIsIon. Iacra are 11mi edsson an Yze for dads. (!Sx, A GAC07 B _n7f (f and (6)!
%'L'Orki?.O be cOiYdUcted N ors land iniust indicate am access and indicate any T.r ees that are to be reritoved. 7he
�,vark Corridor should be described. The approved acee_=s corridor shsll be r esto re-d _"` a-gi g, soil, co s_= -s j _t'!on
c a Kid a th a butt Tr- [jS: iLICA. r 07: -1 _05TJ± cr!C 25 A. 1uY'.r.0 M .10243 '41vti
5%4rmwe,.er cannot Z)8 pipeci or cli21- aled Tor Glract disc -arge to the lakC?- All construc_eC sto Fi7-w2te
dESCficrg?S ftiust be a: he n-atur ai lakc-tiQn and discharged prior to ant ring the buffFer directed as dffus2 yr
-halt ilow et non--rGSiva L.,el0 lies o t.s a Im e. f F5r NCAC 023 .02 3 (5)
l�J I_
i /V� ltel �::11}SIGLe LS:GL I :have been in1 oSr[ICC ()1 the
eCcL2v-jb:�
Ri,ozrian Buffer Rule. . nV m rk condi. d d in he buWa not sped tce ly _t �h� vreed
r stated !I'i a�r,'lliCniEQn G7lC, o,t}�r0
by tha Division 3i Water Rwmrces (DOWPI), is a -AMon and sutlect to enforcement. Due dilEggence s?:silk be
taken such char. the ConrLr uction milli be bulb fttiihirt substa. itlal compliance and it`l mnt of the `'-`05 LtVwmT—
CI
, laht%j Cet tll[Cettion alld BJllGr'Rules, the spproved -n!P-n r) and apeciiicaGionyh and QihersuppoMnE
Signa u,a (awnz;-�11�_� OIL,,
Contact Name*
TAMARA HAGER
Contact Email Address*
HAGER@LAKEPERMIT.COM
Project Owner*
DANIEL GINGERICH
Project Name*
GINGERICH
Project County*
Lincoln
Owner Address:*
Street Address
8112 TADLOCK TR
Address Line 2
aty
DENVER
Postal / Zip axle
28037
Is this a transportation project?*
C Yes c: No
Type(s) of approval sought from the DWR:
F- 401 Water Quality Certification - W 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
us
Do you know the name of the staff member you would like to request a meeting with?
NONE NEEDED
Please give a brief project description below and include location information.*
RIP RAP BARE ERODED AREAS FOR SHORELINE STABILIZATION
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 8/10/2021
Lake
(Ai Full Pond/Normal WaterLe,,ei)
Normall Wate
me QQ
ShorL-Hn
G � lriT��L• ��
aiease approxiely sketch the following informati
maton on this plan (
'�L'Provid1}7, StICF} gg�QftXlQDft`�* e dirnensionsTareach
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
4• Location of any Proposed structures such as buildings, retaining walls,
elevation
�. ocation of is ! ny excavation or dredging below the Full Pond/ NormalWaocks, etc,
rer Level elevation
Location of construction access corridors
FORM. SSGP ? Q-2013
Page 3 of 3
Lake
(Ai Full Pond/Normal WaterLe,,ei)
Normall Wate
me QQ
ShorL-Hn
G � lriT��L• ��
aiease approxiely sketch the following informati
maton on this plan (
'�L'Provid1}7, StICF} gg�QftXlQDft`�* e dirnensionsTareach
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
4• Location of any Proposed structures such as buildings, retaining walls,
elevation
�. ocation of is ! ny excavation or dredging below the Full Pond/ NormalWaocks, etc,
rer Level elevation
Location of construction access corridors
FORM. SSGP ? Q-2013
Page 3 of 3
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