20220989 Ver 1_Shoreline Stabilization_20220721

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 7/21/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Karen Eckart
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
4700 Stone Ridge Tr1
Address Line 2
City
Sarasota
Postal / Zip Code
34232
State / Province / Region
FI
Country
[e-mail]
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Dean Fisher
Company Affiliation: * Lake Norman Custom Dock & Pile Driving, Inc
Email: * [e-mail]

Phone Number: *
Mailing Address: *
[phone]
(xxx)xxx-xxxx
Street Address
PO Box 1439
Address Line 2
City State / Province / Region
Denver NC
Postal / Zip Code Country
28037 United States
A signed and dated copy of the Agent Authorization letter: *
Agent form.pdf 125.6KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Eckart 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
Upload Map: 793 Kemp Rd - Google Maps.pdf 605.25KB
Latitude: * 35.564233
Longitude: *-80.950284
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*
drawing.pdf 43.28KB
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.)
Eckartl.pdf 717.03KB
Eckartl.pdf 677.97KB
Eckartl.pdf 644.04KB
Eckart4.pdf 679.23KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Mooresville
County: * Iredell

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: *
793 Kemp Rd lot #181 Mooresville NC 28117
Include phase/lot number
Directions to site: *
Take NC-150 E towards Mooresville. Turn right onto Morrison Plantation
Pkwy. Use the right 2 lanes to turn right onto NC-1100Brawley School
Rd. Turn right onto McKendree Rd. Turn left onto Kirkwall Pl. Turn right
onto Kemp Rd. Turn 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
0.75
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Repair of damaged stone wall caused by wave action. Installation of footer
with compacted gravel to create base level at shoreline to prevent scour of
wall. Installation of segmented block to create 2 to 3 ft wall height.
8. How will the work be done?*
O From Land
O 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.)
2300 sq ft
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.)
690 sq ft
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)
manicured lawn
Sketch: Catawba Rip Form.pdf
plot plan.pdf
Application Fee:
205.69KB
282.24KB
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:* Dean Fisher
Signature:
Ograff 4?wiert
Submittal Date: 7/21/2022

Initial Review
Is this accepted into the review process?* O Yes 0 No
Project Number: * 20220989 Version: * 1
Select Reviewer: * Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* 0 No Payment Needed
O Fee Received
® Need Fee - send electronic notification
What amount is owed?*
® $240.00
O $570.00

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 181 PLAN NO. PARCEL ID: 4626-05-6967
STREET ADDRESS: 793 Kemp Rd. Mooresville NC 28117
Please print:
Property Owner: Karen ECkart
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher, President , of Lake Norman Custom Dock & Pile Driving , 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 Owner's Address(if different than property above):
4700 Stone Ridge Trl. Sarasota, Fl 34232
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
x Ka-
Authorized Signature Authorized Signature
Date: 1-112Z/ 02.I Date;

7/20/22, 5:10 PM
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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address:Eckart shoreline/793 Kemp Rd Mooresville NC 28117 County: Iredell
Owner: Karen Eckert x k'[44,
Print Signature
Contractor/agent: Dean Fisher
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. 115A 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. j15A 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, Karen Eckert , 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); x k°emr-64-AAL-&-t--
Date: f2z.1zi7Zl

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