20220946 Ver 1_Shoreline Stabilization_20220714

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 7/14/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Anna Gorman
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
4107 Wild Partridge Road
Address Line 2
City
Charlotte
Postal / Zip Code
28226-7127
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:*
Gorman Signed Agent Authorization.pdf I44.24KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Gorman 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:*
35.649387
Street Address
178 Honeydew Circle
Address Line 2
City State / Province / Region
Troutman NC
Postal / Zip Code Country
28166 US
Longitude: *-80.915913
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*
Gorman Detailed Site Plan and Misc. Info.pdf 973.02KB
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.)
Gorman Shoreline Photos.pdf 596.48KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Troutman

County:* Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: *
Crescent Land + Timber Corp. Section 18, Lot # 31
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 42 Troutman, Left onto US-21 NB/Main Street, Left
onto Wagner Street/Perth Road, Right onto State Park Road, Left onto
Morrison Farm Rd, Left onto Stillwater Drive, Left onto Honeydew
Circle, Proceed straight and take right at the "Y". Property is on the right.
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 .7 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shoreline Refresh for stabilization and erosion control. Pull down existing
stabilization and place geotech fabric on shaped shoreline. Replace rip rap
along shoreline.
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.)
1,528 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.)
671 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)
NONE
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

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
a I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Donna P. Hrko
Signature:
Submittal Date: 7/14/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220946 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: 31 PLAN NO: PARCEL ID: 4639068726
STREET ADDRESS:
178 Honeydew Circle
Troutman, NC 28166
Please print:
Property Owner: Anna Gorman
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
DONNA P HRKO , of LANCASTER'S CUSTOM DOCK& LIFT 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):
4107 Wild Partridge Road
Charlotte, NC 28226
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best our kn ledge.
• ed Signature Authorized Signature
7-5-2022
Date Date

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)
131xg'� 1, 048s-P
4-Ox 12'= 4?:(3 5- - 4,��
I I3! ` , Z 5z8&F
•Full Pond/ Normal Water Level �1 '
«::::� i
C� m Y �` 7a=�ti 4� r!w +i � tif~���1
Shoreline
r.w7..yvor�7.....rr..r ��r'�►• �aa., ..+�aai.r — i —IT x 11
f.. 171 Sf
F
Fl?
6tY
Io
Plan View
Lake
LAr Full Pond/Normal Water lerefl
Existing Dock
30rtx7fi
N- �aRINSI ,,yyam� 3rtt t5Qft
�irw�r �'rw.it aelowfJN pond/NWL
Full Pond/Normal Water Level
r
' t�e ak.Isoh
RK R{��p 4 Above fu7urdINWL
2 ft.a150 it. 04/1.11110.0.
additfanal clearing
'If Elecessary
I
E . AMPLE
Plan View
E Q
�j North Carolina Department of Environmental Qualify /Division of Water Resources
`� 51 Norrlt Salisbury Street 11617 Mail Service Center I Raleigh.North Carolina?7699-1617
6.wnmeni nicnnmeetal wiry 919.707.9000

ti
1 �' �
1
Lake 114
(At Full Pond/Normal Water Lev — p ;
tP TT)
.())/ pot
N V
Side View 0
u_
FORM:S$GP 09-2020 Page 5 of 6

o8f12/Yiall UJ:li
DMULL1Pl-L4;V En
I`N17E n.71 UO
THIS IS TO CERTIFY THAT ON THE 12 DAY OF AUBLJSt 20 11 AN ACTUAL
SURVEY WAS DONE UNDER MY SUPERVISION OF THE PROPERTY SHOW HEREON. THIS MAP IS NOT INTENDED
TO MEET GS 47-30 RECORDING REQUIREMENTS.
Lake Norman
H
Screen
Paten
5Eory
w rrcme
„ 178
LEGEND
SIGNE�pp�/1.t.+�.d•
"- PaQ ERn LINE �'I1w-BAUcomo - oA 5 c0 it�LlcE E Wo. C- BZ a :WNfY0R5
S.I.R. RE-sET pl REaMI 52S UNlh CCyE ue
C.I.R, E><iSi1NGG g4 AER.W
E.I.P, E%FS1WC Nr1N i'PE PPc (7ph 5qE- EE
pE E$CEEOS 11, 1 g000'
P.O.E
P.O.E POLIO DRAINAGE EASEMENTT yiylfllrl
S.0 N.
Fil5P STORNI pCgfA ELCRS.JMENi ��yyE G'� f����'�
7 5 PROPERTY SMIE O EASEMENTS Or REC+,NO ,y� H ;044 ,�
�" AAJdNER PROPERLY i.UNE eY DEED OR PIAr ♦+ F' H5,«""�h h I ��
CONSIOER PRELIMINARY UNLESS E NEE AEA sum ~�. a+��.'"�.e� 49 =
if t�C/ SEAS.
L-3748
$� 0 15.01P Av ,
a /P P
''''''CK II?1111y'''''''
Curve Radius Arcfength Chord 6eorinr Chord
C1 Ra=$4.34 L=84.33 N 37' 15' 41' E 62.62'
Lake Norman
Pi _ D�+erPeo.�OtAiGe� _ -
setback
•
80' Public R/W
oreI eve Circle
Power Pole
Physical SURVEY
OF
Lot 31, ReGreitfon Lots Section 18, Lots 27-35
Popwleer
P
rr'
E.I.R. .L2-5'- �.
▪ ---,Po+vcr C .75 .5)1/
aora
Leesburg Lane
R/W
Foflstown Township, lredell County, NC
SCALE 1"=40'
THE PROPERTY OF James T. Gorman And Wife, Anno S. Gorman
NAP RECORDED IN BOOK 13 AT PAGE 49 DEED RECORDED IN BOOK 597 PAGE 79
Drawn By: PAT
.fob Number: 89692

Iredell Count
Printed July 10, 2022
See Below for Disclaimer
" : "s Feet
Addresses
• Infrastructure
' NonResidential Use
' Residential Use
Streets
— interstate
Ramp
—
USFiVy
State Hk/
- ivlain Road
Local Road
Residential
Private
Inactive
Parcels Hocks
Parcels
Parcel Labels
City Limits
Lake Norman
redell Countyline
•
NC Counties
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 1000:3€"' 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 Collectors Office.

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address:
Owner; cA_GD rsevia
Print
Contractor/agent:
Print
County; I r e c4 e I t
NC?S11n[o
A1-47)(2/N
Signature /64
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 .050E 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 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 028 .0243(5), (6)]
Acknowledgement of Notification
Aiina Corfncin , hereby state that I have been informed of the Riparian Buffer Rule. Any work conducted in the buffer, not specifically stated in the application lli at naand s
p y ppapproved
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 Bu#e uj1 s, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner):
Date: 7- 5-Z&

446t1r4;,1111101111011411
•
A