20221044 Ver 1_Shoreline Stabilization_20220803

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 8/2/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Cantilever Holdings (by Pat Deely)
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
247 West Kingston Avenue
Address Line 2
City
Charlotte
Postal / Zip Code
28203-4435
State / Province / Region
NC
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:*
Signed 3094 Bass Dr. Agent Auth.pdf 320.82KB
Signed Catawba Riparian 3094 Bass.pdf 318.4KB
Signed Catawba Riparian 3094 Bass.pdf 318.4KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Deely Shoreline Project
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. *
0 Upload File
® Look up address
Property Address Lookup: *
Latitude: * 35.604932
Street Address
3094 Bass Drive
Address Line 2
City State / Province / Region
Sherrills Ford NC
Postal / Zip Code Country
28673-7710 US
Longitude:* -81.021639
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*
3094 Bass Dr. Diagram.pdf 178.45KB
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.)
Deely photo 1.pdf 7MB
Deely photo 2.pdf 6.86MB
Deely photo 3.pdf 6.81MB
Deely photo 4.pdf 7.85MB
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: *
3094 Bass Drive/ Lot 4
Include phase/lot number
Directions to site: *
NC Bus S to left onto Mt. Beulah Rd to right onto Little Mountain Rd to
left onto Ingleside Dr to left onto Bass Dr. 3094 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: *
Vacant lot, residential dwelling to be built. Existing rip rap shoreline.
Residential, undeveloped, etc.
6. Property Size .44
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Install Rip Rap on top of existing Rip Rap, remove brush and 1 tree along
the 100 lineal feet of shoreline. The tree to be removed is in Photo 1,
attached. Add Rip Rap to the shoreline where none is currently: shape
bank, install Geotech fabric, install Class "B" rip rap.
8. How will the work be done?*
L ;i From Land
C 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.)
400
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.)
100
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, vacant lot
Sketch: 3094 Bass Dr. Diagram.pdf 178.45KB

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:* Randy Jordan
Signature:
e ,reVoldif
Submittal Date: 8/2/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20221044 Version: * 1
Select Reviewer: * Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?* $240.00
$570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 4 PLAN NO: PARCEL ID:
369804911169
STREET ADDRESS:
3094 Bass Dr.
Sherrills Ford, NC 28673
Please print:
Property Owner: Cantilever Holdings (by Pat Deely)
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):
247 W. Kingston Ave
Charlotte, NC 28203
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
PA RAI
Authorized /2022ture
Authorized Signature
Date Date

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: `-jaunty.
Owne
Print4skiature ''�:.� •,I
Contractor/agent:
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)]
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)1
Benching and grading in the buffer is not allowed. Excessive disturbance of ground cover_ [15A 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. f 15A NCAC 02B .0243(4) and (6)1
Work to he 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 out irie 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
, hereby state that i have been informed of the Catawba
Riparian Buffer Rule. Any work conductedlri 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: ''

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address:
`-jaunty.
Print ?feature ' '� :.t_ ,•
Contractor/agent: -_.. :. . _
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 he 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)1
Benching and grading in the buffer is not allowed.Excessive disturbance of ground cover_ [15A 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.f 154 NCAC 02B.0243(4)and(6)1
Work to he 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.115A 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
•
' � - ,hereby state that i have been informed of the Catawba
Riparian Buffer Rule. Any work conductediri 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:
1Z �

Lake
(At Full Pond/Norma!Water Level)
Full Pond/
t.
Normal Water l �y : la 4 r'
Shoreline
•
_. C
•
Please apprcimately 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

1.." '
o:.

Lake
(At Full Pond/ Normal Water i evel)
Full Pond/
Normal Water Level
mar. ...--
Shoreline
Please appriimately 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