20220320 Ver 1_Shoreline Stabilization_20220301

Shoreline Stabilization Application Form
NORTH CAROLINA
EnWnnmentufQu&lry
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TIME
Submission Form
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:
[e-mail]
Please provide an email address for payment and requests for more information here.
Name:* John Barja Jr.
Email: * [e-mail]
Phone Number: [phone]
(x)o)xxx-xxxx
Mailing Address: * Street Address
113 Anglers Place
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117 US
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation: *
Email:*
Phone Number:*
Janice Estep
CBC Stone & Recycling, LLC
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address: *
Street Address
638 Oakridge Farm Hwy
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28115 United States
A signed and dated copy of the Agent Authorization letter:*
Auth. Form.pdf 542.41 K B
Link to: Sample Agent Authorization Form
Project Information [15A NCAC O2H .O5O2(a) & (b)]
Project Name:*
Barja 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. *
Upload File
Look up address
Upload Map: Survey.pdf 989.68KB
Vicinity Maps.pdf 6.3 M B
Latitude: *
35.546374
Longitude: *-80.895619
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*
Site Plan.pdf
Buffer Form.pdf
Please use the diagram at the link below:
903.5KB
969.19KB
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 Pics.pdf 24.72MB
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: *
Lot 129 Commodore Peninsula
Include phase/lot number
Directions to site: *
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
15 s (197 ft)
Turn right onto E Center Ave
2 min (0.5 mi)
Continue on S Church St. Take E Catawba Ave to W Wilson Ave
3 min (0.6 mi)
Turn left onto S Church St
0.3 mi
Turn right onto E Catawba Ave
0.2 mi
Turn left onto S Academy St
0.1 mi
Take NC-1100/Brawley School Rd to Stutts Rd
11 min (5.4 mi)
Turn right onto W Wilson Ave
1.2 mi
Continue onto NC-1100/Brawley School Rd
1.0 mi
Continue straight to stay on NC-1100/Brawley School Rd
3.2 mi
Follow Stutts Rd to Anglers P1
3 min (1.7 mi)
Turn left onto Stutts Rd
1.7 mi
Turn left onto Anglers P1
141 ft
113 Anglers P1
Mooresville, NC 28117
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
Residential, undeveloped, etc.
6. Property Size
0.25 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Remove undermined trees on immediate shoreline necessary to properly
stabilize bank. Install matting and install class "B" rip rap for new
shoreline stabilization.

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.)
4' below (468 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.)
1' above (117 sf)
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)
Grass buffer, remove trees and brush on immediate shoreline, no
disturbance to buffer.
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:
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");
a 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 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: * Janice Estep
Signature:
csaxrjfr p v[n%.
Submittal Date: 2/25/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220320 Version:* 1
Select Reviewer: * Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* ( No Payment Needed
C Fee Received
C• Need Fee - send electronic notification
What amount is owed?*
C• $240.00
C $570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID:
STREET ADDRESS: i 13 nq lers
Moore .0) ( � N\c. a F,11
Please print:
Property Owner: Torn v1
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Jan ice ES e , of C,PIC cvt-cone_ ec3C� nc� LLC
(Contractor / Agent) (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 Owner's Address (if different than property above):
Telephone: 104- Li GI 1 - (j3/-15
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
i
Authorized Sig, re
Date: a- aa- `)•DN,
Authorized Signature
Date:

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Legend
113 Anglers PI
wieffestawisomenverm

Full Pond/
Normal Water Level
Shoreline
Lake
(At Full Pond/Norrnai Water Level)
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houses
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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
3. 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 or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

CATl AWBA ROPM N BUFFER NOTIIFIIC T(ON FORM
M
Project Name/address:
Owner:
County:
Print
Contractor/agent: S'�c3Yle e `le_
Print
Signature
LLC
Sishaktire
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, construction
material must be outside the buffer. [15A NCAC 021-1.0502 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 028.0243(5), (6)]
Acknowledgement of Notification
1, hereby state that i have been informed of the Catawba
Riparian Buffer Rule. 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_ 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 approved plan(s) and specification(s), and other supporting
materials.
Signature (owner): r�
Date:
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