20211445 Ver 1_Shoreline Stabilization_20211001

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:
DWR Pre -Filing Meeting Request Form.pdf 49.71KB
Pre -fling Meeting or Request Date 8/27/2021
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 *
Owner Information:
Name:*
Email:
*
Phone Number:*
Mailing Address:*
[e-mail]
Rease provide an email address for payrrent and requests for pore information here.
Patrick S OBrien (Carolina Hideaway, LLC)
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
615 St Vincent St
Address Line 2
CitY
South Bend
Rbstal / Zip Code
46617
State / Rovince / Region
Indiana
Country
United States

Is there an agent working on the
project?*
r Yes
C: No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Carolina Hideaway 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
C: Look up address
Property Address Lookup:*
Latitude:*
35.616126
Street Address
2820 Camden Pointe Drive
Address Line 2
City State / R -ovince / Region
Sherrills Ford NC
Rbstal / Zip Code Country
28673-7281 US
Longitude:* -80.939328
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*
Shoreline Sketch.pdf 348.4KB
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 Sketch for Filing.pdf 347.5KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Sherrill's Ford
County: * Catawba
Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address:* Lakepointe South Lots 24 and 25
Include phase/lot number
Directions to site:*
From I77, go west on 150 over the lake, Go right on Sherrills Ford Road,
go right on Island Pointe Road, Go right on Camden Point. The property
is at the end of the street.
Rease include road naves and nutt-Wrs, landmarks etc.

5. Describe the existing land use or condition of the site at the time of this application:*
Lot 2820 is developed as a residential home and has a dock. Lot 2815 has
a doc but does not have a home on it at this point.
Residential, undeveloped, etc.
6. Property Size
2820 (lot 25) is 1.35 ac. 2815 (24) is
1.43 ac.
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Added rip rap to existing rip rap around the perimeter of both properties.
Lake traffic has increased so the thought was that adding additional stone
would eliminate future erosion. Rip rap was not in disrepair.
This is an after -the -fact application per Alan Simpson. The stone has
already been added. My apologies.
8. How will the work be done?*
rJ 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.)
1800 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, backfill, excavation, rip rap, retaining walls, etc.)
3600 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:*
(number of trees, for instance)
Two trees were impacted prior to the start of the project. They needed to
come down regardless from a safety standpoint. They were severely
compromised trees with exposed roots so I had them professionally
removed to eliminate this issue. I replanted 1 tree (and have planted 20+
trees since owning the property). Pic attached of exposed roots.
Sketch: Compromised trees.pdf 932.8KB
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:
a I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
a 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.
a 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");

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:*
Signature:
Patrick S OBrien
Offeekie
Submittal Date: 9/30/2021

Initial Review
Is this accepted into the review fr Yes 0 No
process?*
Project Number:* 20211445
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Version:* 1
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