20211581 Ver 1_Shoreline Stabilization_20211102

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:
Campbell 128 DWR Pre -Filing Meeting
112.44KB
Request Form.pdf
Pre -fling Meeting or Request Date 9/14/2021
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* donna. [e-mail]
Please provide an email address for payment and requests for more information here.
Owner Information:
Name: *
Margaret L Campbell
Email: *
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
616 Charming Circle Northwest
Address Line 2
City
State / Province / Region
Troutman
NC
Postal / Zip Code
Country
28166-7645
United States

Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Donna P. Hrko
Company Affiliation: * Lancaster Custom Dock and Lift Systems, Inc.
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address: * Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
North Carolina
Postal / Zip Code
Country
28166
United States
A signed and dated copy of the Agent Authorization letter: *
Campbell 128 Signed Agent Authorization
150.481CB
Letter.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
.........................................................................................................................................................................................................................
Project Name: * Campbell Shoreline Refresh (Adjacent Lot to 136)
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.*
Upload File
• Look up address
Property Address Lookup:* Street Address
128 Claiborne Drive
Address Line 2
City
Mooresville
Postal / Zip Code
28117-9201
Latitude: * 35.511813
State / Province / Region
NC
Country
US
Longitude: *-80.951464
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*
Campbell 128 Site Plan and Back-up.pdf 1.3M13

Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/O/edoc/616616/Shoreline%2OLayout.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.)*
Campbell Shoreline Photo 128.pdf 170.77KB
Campbell Aerial Photo 128.pdf 3.96MB
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: * Crescent Land + Timber Corp. Section 6 Lot 236
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 35, Left onto Brawley School Road, Right onto
Tuskarora Trail, Right onto Balmoral Road, Left onto Clairborne Drive,
Property is on the right near the end of the road.
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:
Residential Lot
Residential, undeveloped, etc.
6. Property Size .72 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shoreline Refresh with Class A rip rap and geotech matting for
stabilization and erosion control.
8. How will the work be done?* From Land
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.)
471 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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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:* Donna P. Hrko
Signature:
o
Submittal Date: 10/31/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211581 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Alan Johnson: eads\adjohnson I
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 236
STREET ADDRESS:
128 Claiborne Drive
Mooresville, NC 28117
Please print:
PLAN NO:
Pro a Owner; Mar aret Cam hell
Property Owner:
PARCEL
ID;4614963818
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko
(Contractor/Agent)
of Lancaster Custom Dock and Litt 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):
616 Channing Circle NW
Concord, NC 28027
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
5a
C'
Authorized nature Authorized Signature
1d/25/2
Date
Date

12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All 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 drarfgina himinter rho Gi ill D^r A 1 KI— l
Full Pond/ Normal Water Le
Shoreline
Plan View
FORM: 55GP 02-2017
r ••-- ..u«.� �-cVct G- CVC]LI U;I
Lake
(At Full Pond/ Normal Water Level)
6cpsh
won
0
Lake
{At Full Pffl&hamal Waler Lw. Jj Existing pock
30 hx7ft
3kx]5p f[
FUH Pondl NormaaaI Water Level b" U pod "WL
1�Dr iflnE i k x i5a k
} Riprap Ahamr foil pond/ NWL
zft.xiwn.
as&tom eltar ft
`Nnecesaary
E AMP E
Plan View
ass
)]e1O•�►1 t7400
Page 3 of 4
q-4

t
5
J
Lake
(At Full nd/ Normal Water Lev
'af
a
,C
C—
Side View0
U-
3 ft. below full pond water Ievei 4 ft. above full pored water level 2 ft• additional clearing
*if necessary
Existing bank
10 ft. bank
height yQa
I J<ep
Side Wl,,
_ ter►
FORM: SSGP 02-2017 Page 2 of 2

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CATAWBA RIPARIAN BUFFER NO 1FICATION FORM
Project Name/address: b r County: 1 re.de �l _
r0.� r]Drh .�eSv� [te, � _ _�// 10 DWner: Man ►� o-� t `r...�.. n4, a 1 f r� n �.,�
Priny i n re
Contractor/agent:
Print Sign
The approval is for the purpose and design described in Wur 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 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 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, 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 velocities to the lake. [15A NCAC 0 2 B .0243(5), (6)]
Acknowledgement of Notification
I, Y' ,i' T ,hereby state that I have been informed of the Catawba
Riparian B er Ruie. Any 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. Du 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 specificat ion[s], and other supporting
materials.
Signature (owner): Date:

Iredell County
Property Data
Parcel Number: 4614963818.000
Inquiry Date: 10/27/2021
Disclaimer: While every effort is made to keep information provided over the Internet accurate and up-to-date, the County does not certify
the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping data
herein, or for their use or interpretation by the User.
Property Map
Owner/Property Info
Tax Account Number: 77392715
Old Parcel Number: 001 382 51
Owner Name: CAMPBELL PAUL T+MARGARET L
Mailing Address: 616 CHANNING CIR NW CONCORD NC 28027
Properly Location: CLAIBORNE DR
Lot Number: 236
Legal Description: CLT 56 M17-625 MECK NECK PB34-29 REV PB60-119
Municipal Information
Township Code: 17
City Code: Null
Neighborhood Code: 17018
Value Information - Current Year Pro e�rty RggLrd Card (PRC).
Building Value: 78570
Other Building Features: 34910
Land Value: 546250
Tax Assessed Value: 659630
Deferred: a

Land information - Register of Deeds Online Search
Date Recorded Document Type Deed Book Deed Page Plat Book & Page Land Area Land Type Zoning
20030917 WD 1484 2375 60-119 0.73 AC R-20
Tax Infortna#ion
Exemption Tax Code 1 Tax Code 2
Tax Code 3 Tax Code 4 Tax Code 5
Null C AdVLTAX Null
FR06ADVLTAX Null Null
Current Zoning Contact Info.
Iredell County
7D4,878.3118
Harmony
704.878,3118
Love Valley
704.878.3118
City of Statesville
704.878.3575
Town of Troutman
704.528.7600
Town at Mooresville
204.662.7040
Village of Davidson
704.892,7591

VIA
OL-
JP

VI
0

Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:
Is this a transportation project?*
donna. [e-mail]
donna. [e-mail]
Paul and Margaret Campbell
Cambell Shoreline Refresh (Adjacent Lot to 136)
Iredell
Street Address
128 Claiborne Drive
Address Line 2
City
Mooresville
Postal / Zip Code
28117
Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - 401 Water Quality Certification -
Regular Express
Individual Permit Modification
Shoreline Stabilization
Does this project have an existing project ID#?*
Yes No
State / Province / Region
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 by pulling down existing Class B rip rap and
installing geo-tech fabric. Push the Class B rip rap back over the geo-
tech fabric. Install new Class A rip rap over existing Class B rip rap
and new matting.
NOTE: This lot is adjacent to 136 Claiborne Drive which has been
previously pre -filed for shoreline refresh and dredge.
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.
Signature*
Submittal Date 9/14/2021