20220537 Ver 1_Shoreline Stabilization_20220406

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:
Name:*
Email:*
Phone Number:
Mailing Address: *
[e-mail]
Please provide an email address for payment and requests for more information here.
Darhyl Pulley
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
208 Pinnacle Shores Drive
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-5819 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:*
Agent Form.pdf 578.74KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC O2H .O5O2(a) & (b)]
Project Name:*
Pulley 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: Plat Map.pdf 1.44MB
Vicinity Maps.pdf 8.31MB
Latitude: *
35.610555
Longitude: *-80.928680
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:
978.81KB
1.05MB
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 23.59MB
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 36 Pinnacle Shores Subdivision
Include phase/lot number
Directions to site: *
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
197 ft
Turn right onto E Center Ave
0.5 mi
Turn left onto S Church St
397 ft
Turn right onto E McLelland Ave
1.1 mi
Use any lane to turn left onto NC-150 W/E Plaza Dr
Continue to follow NC-150 W
Pass by Zaxby's Chicken Fingers & Buffalo Wings (on the right in 1.3 mi)
6.0 mi
Turn right onto Pinnacle Shores Dr
Destination will be on the right
0.4 mi
208 Pinnacle Shores Dr
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
1.18 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Push down existing stone. Reshape and re -slope shoreline, install matting,
install boulder rip rap to refurbish. Install TN Crab Orchard steps.
8. How will the work be done? *
r.' 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.)
8' below (1424 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.)
2' above (356 sf) 10'
x 50' access
corridor (500 sf of
temp. impact)
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, no trees removed, minimal disturbance to buffer. Access
corridor to be restored to original condition.
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:
Submittal Date: 4/5/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220537 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. 3 (o PLAN NO. PARCEL ID:
STREET ADDRESS: a08 Ri nncke.e cS\rio v eS
nMco.reS�� \\-e , vc as\V 1
r
Pleaseprint:
Property
Owner:--brk UJ I
u e�
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
J a"n"\ ce E S
(Contractor / Agent)
of C° ��_ n e � e CUJ lC.%� Y-] 1 �'
(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: 101 2.gq - 1359
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorizgn
Date: 11-1
I aa,
Authorized Signature
Date:

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CHARLOTTE, N.C. 28202-1003
OH 481 P 91
DAVIDSON TOWNSHIP, IREDELL COUNTY
STATE OF NORTH CAROLINA
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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

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