20220898 Ver 1_Shoreline Stabilization_20220705

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 7/1/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Elain Jacobs and Hope Paasch
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
3672 Lake Shore Road South
Address Line 2
City
Denver
Postal / Zip Code
28037-8236
State / Province / Region
NC
Country
US
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Janice Estep
Company Affiliation: * CBC Stone & Recycling, LLC
Email: * [e-mail]

Phone Number:*
[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 584.02KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC O2H .O5O2(a) & (b)]
Project Name: *
Jacobs/Paasch 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:*
35.503626
Street Address
3672 Lake Shore Road South
Address Line 2
City State / Province / Region
Denver NC
Postal / Zip Code Country
28037-8236 US
Longitude: *-80.984237
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 992.77KB
Buffer Form.pdf 1.06MB
Permission Letter.pdf 5.76MB
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.)
Shoreline Pics.pdf 32.89MB
4. Location of the property (where work is to be conducted)

Nearest Town:* Denver
County:* Lincoln
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:*
Lot 68 & pt. 69 Westport
Include phase/lot number

Directions to site: *
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
14 s (197 ft)
Take NC-150 W, Slanting Bridge Rd and NC-16 Business S to Fairfield
Forest Rd in Westport
35 min (19.7 mi)
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)
9.9 mi
Turn left onto Slanting Bridge Rd
2.7 mi
Continue onto Campground Rd
1.7 mi
Turn left onto Will Proctor St
0.5 mi
Turn left onto NC-16 Business S
3.2 mi
Follow Fairfield Forest Rd to Lake Shore Rd S
5 min (2.1 mi)
Turn left onto Fairfield Forest Rd
1.3 mi
Turn right onto Barker Ln
269 ft
Turn right onto Lake Shore Rd S
Destination will be on the left
0.8 mi
3672 Lake Shore Rd S
Denver, NC 28037
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 0.44 acres
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Remove existing wood wall and haul off. Starting a right property line and
extending left, install a boulder wall on a 100' section of shoreline to
replace old wall. At left side of wall and extending to left property line up
to neighbor's dock, shape and slope a 15' section of shoreline. Install
matting and install boulder rip rap. Cut back existing drain pipe near left
property line and install a boulder rip rap swell from end of pipe to rip rap
on shoreline. Install TN Crab Orchard steps.
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.)
3.5' below for 100'
wall section (350sf)
2' below on 15' rip
rap section of
shoreline (30 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 on 100'
wall section (100
sf) 1' above on 15'
rip rap section (15
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 only small undermined tree on immediate shoreline,
minimal 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):
o $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:
o 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.
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");
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");
o 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: 7/1/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220898 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. lode 4. LoR PLAN NO, PARCEL ID:
STREET ADDRESS: ~S �Z L� S Ulu L
Please print:
Property Owner: ‘V--\ • aGZ.
Property Owner: C
The undersigned, registered property owners of the above noted property, do hereby authorize
Janice ESFe1 of �t�C_ S--one E e.cgc n3 1 LC
(Contractor I 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: `Moil- LSo- a-189
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signatu fy Authorized Signature
Date: ^ �Z- 2��Z
Date: Co [22/ ?o22_

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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

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: �I ,2 �-s� 'c��` 5 �1 -a G County: Ltv\CJiLA-----"
Owner: V-"kN Cce 11Au G t o c'l � � � c ` ��;✓ -1---_
Print Signature
Contractor/agent: C3C 5--one c� c_I,r LAC n,O Ea`
Print 3_._
Si ature
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 1SA 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 02H .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 02B.0243(5), (6)]
Acknowledgement of Notification
I, 00, p _Taco [ L l�Cc0.5C�� , 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): Lip f Z� cs2�
_ _ Date:

SharingWViiteri owner of Lake Norman Dock and Dredge,
hereby give permission fcr CET Stone g Becyritn& t tC tu use
nv tummerrial pi°pert's/ cue at 46E1 S;aritirg Bridge
Shetrilis lac, NC 2U73 65 an access/equipment staging drea
tor ti,e puroose of loArl ne rnateria1 en to harp to bt
for snoreiirse project with no13nellccess tor II airvp Jacob%
mai PEI at 3672 Lake Shore Rd. South Delver, PIC 213117
ih-bocofelzr
Sign
Date

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3397-1127
FILED ELECTRONICALLY
CATAWBA COUNTY NC
DONNA HICKS SPENCER
FILED May 04, 2017
AT 01:32:00 PM
BOOK 03397
START PAGE 1127
END PAGE 1128
INSTRUMENT # 07583
EXCISE TAX $0.00
GENERAL WARRANTY DEED
Excise Tax: $0.00
This conveyance is without consideration and is a business distribution. No revenue stamps are required
pursuant to N.C.G.S. 105-228.29(6).
Tax Parcel ID No.: 460602870545 Verified by: Catawba County
on the day of , 20 By:
NO TITLE OPINION RENDERED-NO CLOSING HELD BY PREPARING ATTORNEY
Mail/Box to: ,Kevin C. Donaldson, Attorney, PO Box 3010, Mooresville, NC 28117
This instrument was prepared by: Kevin C. Donaldson, Attorney at Law, Jones, Childers, Donaldson &Webb, PLLC,
149 Welton Way, Mooresville, NC 28117
•
Brief description for the Index:
THIS DEED, made this the 25th day of April, 2017, by and between
GRANTOR: Lake Norman Dredging& Marine Construction, Inc., a North Carolina corporation
whose mailing address is PO Box 3156, Mooresville, NC 28117 and
(herein referred to collectively as,Grantor)and
GRANTEE: Thomas Shannon Miller,a married man
whose mailing address is PO Box 3156, Mooresville, NC 28117 and
(herein referred to collectively as Grantee)and
• WITNESSETH:
For valuable consideration from Grantee to Grantor, the receipt and sufficiency of which is hereby acknowledged,
Grantor hereby gives, grants, bargains, sells and conveys unto Grantee in fee simple, subject to the Exceptions and
Reservations hereinafter provided, if any, the following described property located in the City of, Township of
Mountain Creek, County of Catawba, State of North Carolina, more particularly described as follows:
All that certain tract of land located in Mountain Creek Township, Catawba County, North Carolina,designated
as "4.235 Acres Total" on plat prepared by Gregory S. Flowe, P.L.S., License No. L-3600, entitled "Property
Owned by Carolina Centers, LLC, CRI# 3458-00, Map Showing Portion of UMI-99 (Mrs. N. S. Gordon Tract),"
dated September 2, 2002, which plat is attached to that certain deed recorded in Deed Book 2474, Page 802
and which plat is incorporated herein by reference.
Said property having been previously conveyed to Grantor by instrument(s) recorded in Book 2474, Page 802, and
being reflected on plat(s) recorded in Map/Plat Book , page/slide .
Submitted electronically by "Jones, Childers, Donaldson & Webb, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Catawba County Register of Deeds.
Revised December 17, 2009

3397-1128
All or a portion of the property herein conveyed _includes or _X_ does not include the primary residence of a
Grantor.
TO HAVE AND TO HOLD unto Grantee, together with all privileges and appurtenances thereunto belonging, in fee
simple, subject to the Exceptions and Reservations hereinafter and hereinabove provided, if any.
And Grantor hereby warrants that Grantor is seized of the premises in fee and has the right to convey same in fee
simple, that title is marketable and is free and clear of encumbrances other than as set forth herein, and that Grantor
will forever warrant and defend the title against the lawful claims of all persons or entities whomsoever.
This conveyance is made subject to the following Exceptions and Reservations:
1. ANY AND ALL EASEMENTS, RIGHTS OF WAY AND RESTRICTIONS OF RECORD, including but not limited to
those contained in Exhibit"B"to Deed Book 2474, Page 802.
2. ANY AND ALL ZONING AND PLANNING ORDINANCES.
All references to Grantor and Grantee as used herein shall include the parties as well as their heirs, successors and
assigns, and shall include the singular, plural, masculine, feminine or neuter as required by context.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
Lake Norman Dredging & Marine Construction, Inc., a North
Carolina corporation
ntity Name)
By: (SEAL)
Print/ ype Name&Ttle: homes S. Mi er, Presid t
By: (SEAL)
Print/Type Name & Title:
By: (SEAL)
Print/Type Name&Title:
By: (SEAL)
Print/Type Name&Title:
State of North Carolina (Official/Notarial Seal)
County of Iredell w�uwnuu�ryij
I certify that the following person(s) personally appeared before me this day, ��'����� M
each acknowledging to me that he or she signed the foregoing document:
Thomas S. Miller, President of Lake Norman Dredging & Marine Construction, NGTAR 7
Inc. '
Date: /7 y PUBLICV
t ,Nota �nted or Ty' a me• Notary Public ''%,9p��`�i CO1�������```
�1y�om i�% Expires:
�/nuunI moo
Revised December 17, 2009

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