20220711 Ver 1_Shoreline Stabilization_20220524

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 5/23/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
James Shields
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
767 Morrison Farm Road
Address Line 2
City
Troutman
Postal / Zip Code
28166
State / Province / Region
NC
Country
US
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:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
1156 Perth Road
Address Line 2
City State / Province / Region
Troutman NC
Postal / Zip Code Country
28166-8640 US
A signed and dated copy of the Agent Authorization letter:*
Shields Signed Agent Authorization.pdf 143.29KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Shields Shoreline Refresh
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:*
35.633923
Street Address
767 Morrison Farm Road
Address Line 2
City State / Province / Region
Troutman NC
Postal / Zip Code Country
28166 US
Longitude: *-80.924252
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*
Shields Detailed Site Plan.pdf 1.27MB
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.)
Shields Photographs.pdf 3.41MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Troutman

County:* Iredell
Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address: *
Crescent Land + Timber Corp. Section 17 Lot 1 767 Morrison Farm Road
Troutman, NC 28166
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 42, Left onto US-21 NB/Main St Troutman, Left onto
Wagner St/Perth Road, Right onto State Park Road, Left onto Morrison
Farm Road, Property 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
.923 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shoreline repair and refresh for stabilization and erosion control. Repair
slip area and stabilize with retaining wall. Remove trees that are root
exposed.
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.)
1200 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.)
1000 sf const
corridor and staging
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)
4 trees with root exposure. See attached annotated photo.
Sketch:
Shields Tree Removal Photo.pdf 565.72KB
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.
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");
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");
• 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: * Donna P. Hrko
Signature:
Submittal Date: 5/23/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220711 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: 4629812149
STREET ADDRESS:
767 Morrison Farm Road
Troutman, NC 28166
Please print:
Property Owner: James Shields
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
DONNA P HRKO , of LANCASTER'S CUSTOM DOCK & LIFf SYSTEMS,
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):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Auth ized Signature Authorized Signature
5-1 -2022
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 dredging below the Full Pond/Normal Water Level elevation
Lake
(At Full Pond/Normal Water Level)
Full Pond/ No`l Water eve! . �'.:::: ::: "ter ��w:: . •:,;�. igaDdiactiaL
Shoreline r
4-tYe es
Abe�-e � s��. _ V! gd-S•Vone. r'e- �n i n
r'epQarSEtip4't
Plan View
Lake
{At Full Pundl Normal Water L.•
Existing cock
30 Rx7ft
■ 0,■1�,■ 4 F._ems* 3 k x 350 ft
1 Bel'"11 NWL
Full Pend/Normat Water Level �r"rr�yi{�* S
"a'tgrMne' 414 ■ 4hx150ft
�r RIP WI Careee Above toll aandl kwt
additional clew ring
•11 necessary
E AM P E
FORM:SSGP 02-2017 Page 3 of 4
Plan View

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Lake
(At Full Pond/Normal Water LeNI) 4
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Side View
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3 ft.below full water level 4 ft.above full 2 ft.additional clearing
pondpond water level
"if necessary
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Existing bank •
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FORM:SSGP 02-2017 Page 4 of 4

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 5h I e 1 CLIhnre l I ne REesh County' re r��i (
Owner: t`a. ��— 1 e 1db Si
Pnn gn
Contractor/agent: k V Lstocr!c,-1-e r-
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Si nature
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 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 1SA 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 02B.0243(5), (6)]
Acknowledgement of Notification
hie ! CI 5 , hereby state that l 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): Date: V~ I ZZ

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maps prepared for this website are generated from recorded deeds,plats,and other public records.Users of these maps are hereby notified that the information
vided herein should be verified.Iredell County assumes no legal responsibilities for any of the information contained on this site.Users are advised that the use of
of this information is at their own risk.All maps on this site were prepared using a 1000a€"'Grid based upon the North Carolina State Plane Coordinate System from
1983 North American Datum.The delinquent real property tax overlay is updated monthly.The information presented is not intended to be used or relied upon as
:ial notice of tax liens.For additional information regarding delinquent taxes,contact the Iredell County Tax Collector's Office.

Iredell County
Property Data
Parcel Number:4629812149.000
Inquiry Date: 5/13/2022
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.
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Owner/Property Info
Tax Account Number: 80073077
Old Parcel Number: 1503CO2000A001
Owner Name: SHIELDS JAMES S JR
Mailing Address: 767 MORRISON FARM RD TROUTMAN NC 28166
Property Location: MORRISON FARM RD
Lot Number: 1
Legal Description: CRESCENT LAND+TIMBER CORP S17 PB13-72
iriunicipai Information
Township Code: 15
City Code: 00
Neighborhood Code: 150S1
Value Informatiofs Current Year Property Record Card(PRC)
Building Value: 77300
Other Building Features: 11290
Land Value: 300000
T., A .J U-.I...,. -anvrnn

Land Information -Register of Deeds Online Search
Date Recorded Document Type Deed Book Deed Page Plat Book&Page Land Area Land Type Zoning
20200629 WO 2710 1651 13-72 0.889 AC R20
Tax Information
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 704.878.3118
Harmony 704.878.3118
Love Valley 704.878.3118
City of Statesville 704.878.3575
Town of Troutman 704.528.7600
Town of Mooresville 704.662.7040
Village of Davidson 704,892.7541

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