20220632 Ver 1_Shoreline Stabilization_20220505

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Quality
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 *
[e-mail]
Please provide an email address for payment and requests for more information here.
Pre -Filing Meeting Date Request was 5/4/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Blair Eiler
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
355 Harbortown Dr
Address Line 2
City
Taylorsville
Postal / Zip Code
28681
State / Province / Region
NC
Country
United States
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Mickey Larson
Company Affiliation: * Owner/ LKN PERMITS, LLC
Email: * [e-mail]

Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
631 Brawley School Road
Address Line 2
#166
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-9121 US
A signed and dated copy of the Agent Authorization letter:*
Blair Filer Auth Form.pdf 1.72MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Filer Sea Wall
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: *
Latitude:*
35.810156
Street Address
355 Harbortown Drive
Address Line 2
City State / Province / Region
Taylorsville NC
Postal / Zip Code Country
28681-7644 US
Longitude: *-81.257373
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*
Blair Eiler Site Plan.pdf 3.93MB
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.)
Blair Filer Arial Shoreline View.pdf 173.43KB
4. Location of the property (where work is to be conducted)

Nearest Town:* Hickory
County: * Alexander
Lake/ river/ ocean adjacent to Hickory
property:
Subdivisions name or site address: *
355 Harbortown Dr Taylorsville, NC Lot 11
Include phase/lot number
Directions to site: *
From:Marshall Steam Station 8320 NC-150, Sherrills Ford, NC 28673
Head northwest 3 min (0.5 mi) Follow Sherrills Ford Rd to Lowrance Rd
12 min (9.0 mi)
Follow Lowrance Rd to 8th St SE/Hudson Chapel Rd 4 min (2.7 mi)
Take Oxford School Rd, NC-16 N and Rink Dam Rd to River Hills Ct in
Bethlehem 29 min (19.4 mi)
Continue on River Hills Ct. Drive to Harbortown Dr 4 min (1.7 mi) 355
Harbortown Dr Taylorsville, NC 28681
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
1.09
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Removal of existing dilapidated wooden Seawall
Install a retaining wall system constructed of Verti-Block ( 4x2x3
Concrete Block) to stabilize 490' of Shoreline and prevent erosion
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.)
1470
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.)
2460
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: Blair Filer Site Plan.pdf 3.93MB
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

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
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.
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");
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
a I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Mickey Larson
Signature:
Submittal Date: 5/4/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220632 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: 1 PLAN NO: _ PARCEL ID:, 35•. 17-► j 5'L/7
STREET ADDRESS:
3�5 J-Ia r bOr ow n •
Tate, I o rsv i:le, /4 2—SIRS I
Please print:
Property Owner: Bled Y- ` •!,I aU.r
Property Owner:
The undersigned, registered property owners the above noted property, do herebyauthorize
:ck LCW S01\ , o L.K.N. VGrfy11 c +5 ontractor/Agent) (Name of consul-find 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):
2D15 sill/web/wit. LY
Ij5Piet r t., PA 1504
Telephone: 1014. .255. 92-6
We hereby certify the above information subnliitted in this application is true and accurate tothe
best of our knowledge.
atei4A
Authorized Signaturet v 4
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afe
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