20220633 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 5/2/2022
submitted on: *
Owner Information:
Name: * Lisa Gleason
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
4 W. 14th Street
Address Line 2
City
Frederick
Postal / Zip Code
21701
State / Province / Region
MD
Country
US
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Randy Jordan
Company Affiliation: * Lyfe Marine, Inc.
Email: * [e-mail]

Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
19109 W. Catawba Ave.
Address Line 2
Suite 200
City State / Province / Region
Cornelius NC
Postal / Zip Code Country
28031 United States
A signed and dated copy of the Agent Authorization letter:*
Gleason Agent Auth + Catawba Riparian.pdf 545KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Gleason 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
Property Address Lookup: *
Latitude:*
35.554591
Street Address
5125 Lakeview Circle
Address Line 2
City State / Province / Region
Sherrills Ford NC
Postal / Zip Code Country
28673-9223 US
Longitude: *-80.987485
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*
Gleason Shoreline Diagram.pdf 249.79KB
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.)
Gleason Shoreline Slide 1.pdf 249.01KB
Gleason Shoreline Slide 2.pdf 342.25KB
Gleason Shoreline Slide 3.pdf 222.22KB
Gleason Trees to be removed.pdf 512.45KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Sherrills Ford
County: * Catawba
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: *
Directions to site: *
Asbury Park/ 5125 Lakeview Circle 28673
Include phase/lot number
NC 16N to R onto St. James Church Rd --> Will Proctor St. to R onto
Campground Rd. --> Slanting Bridge Rd to R onto Keistlers Store Rd to L
onto Barkley Rd. to L onto Lakeview Circle. 5125 is on the left.
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
1.64
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Adding Class "B" Rip Rap to the existing shoreline for maintenance.
Pushing down existing Rip Rap, shaping the bank, installing geo-tech
fabric, installing new rip rap. Removing 2 undermined trees.
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.)
2009
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.)
287
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)
Yard, grass, existing trees
Sketch: Gleason Shoreline Diagram.pdf 249.79KB

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
I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Randy Jordan
Signature:
i?eAck ,roccia4
Submittal Date: 5/4/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220633 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

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
' i 2S bra-i t&i_, j�Li 2-` 1 73 County: L. - 'Ct
Project Name/address:
Owner: C-lectSc r 12`
Print Sigp#://07.7
Contractor/agent: Randy Jordan
Print Signature
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)1
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.115A NCAC 02B.0243
(6)1
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),(5),(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 02B.0243(5),(6)]
Acknowledgement of Notification
f L.Ica Cr!iv(LSCV) ,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 plans)and specification(s),and other supporting
materials. hif {
Signature(owner): ' � -- Date:_ 513 J 2

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 3 and 4 PLAN NO: PARCEL ID:
460604829777
S I REET ADDRESS:
5125 Lakeview Circle lit -
Sherrills Ford,NC 28673
Please print
Property Owner: Lisa Gleason
Property Owner:
The undersigned,registered property owners of the above noted property,do herebyauthorize
Randy Jordan , of Lyfe Marine, Inc.
(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 Owners Address(if different than property above):
Fr dec, Gk. PIt 2i701
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Attdrelk--
Authorized Signature Authorized Signature
513
Date Date

Lake
(At Full Pond/Normal Water Level)
Full Pond{
Normal Water Level
Ma NM MIN MI MEN MI Mat MIN
Shoreline
ry
l
:&L,k:
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. Ail 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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Lake
(At Full Pond/Normal Water Level)
Full Pond{
Normal Water Level
Ma NM MIN MI MEN MI Mat MIN
Shoreline
ry
l
:&L,k:
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. Ail 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