20221075 Ver 1_Shoreline Stabilization_20220811

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 8/10/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Kenneth Wade Summerlin II
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
7115 Pleasant Grove Road
Address Line 2
City
Charlotte
Postal / Zip Code
28216-1322
State / Province / Region
NC
Country
US
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Saundra B Mosteller
Company Affiliation: * Dale & Beth's Lake Use Permit Service
Email: * [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
988 Clear Creek Circle
Address Line 2
City State / Province / Region
Lincolnton North Carolina
Postal / Zip Code Country
28092 United States
A signed and dated copy of the Agent Authorization letter:*
agent.pdf 582.05KB
catawba buffer.pdf 820.62KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Kenneth Wade Summerlin (vacant lot)
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:
Latitude: *
directions.pdf 2.84MB
lat long.pdf 67.46KB
vicinity.pdf 354.71 KB
plat.pdf 545.37KB
35.577810
Longitude: *-81.006350
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*
stabilization drawing.pdf 194.18KB
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.)
pictures.pdf 1.14MB
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: *
4252 Harrys Lane Sherrills Ford NC 28673 Lot PT1
Include phase/lot number
Directions to site: *
from 526 S Church St Charlotte NC, head SE on W 1st St toward S
Church St, turn right onto S Church St, take the ramp on the right and
follow signs for I-277 S / US-74 W, at exit 1C head right on the ramp for
I-77 N / US-21 N toward Statesville, at exit 11 B, head on the ramp left
and follow signs for NC-16 N, take the ramp on the right, turn right onto
NC-150 / E NC 150 Hwy, turn left onto Harrys Lane, the immediately turn
right onto Crabapple Dr on 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: *
vacant lot
Residential, undeveloped, etc.
6. Property Size
5.35
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
rip rap redo, due to wave action
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.)
892
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.)
500
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)
no tree removal
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):
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.

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");
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
• I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Saundra B Mosteller
Signature:
Submittal Date: 8/10/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221075 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 :
LET NO. FT 1 _ PLAN Na, _ . PARCEL ID : 46071831 82 l 1
STREET ADDRESS : 4252 HarrvLane Sherrills Ford NC 28673
Please print:
Property Owner: Summerlin & fan LLB (Kenneth Wade Summerlin II
The undersigned, registered property owners of the above noted property, do hereby authorize
Beth Mosefler _ , of Dale & Beth's Lake Use Permit Service
(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) :
71i5P1easantGroveRdCharIofteNC282i6- i322
Telephone: [phone].
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
4 4 A A A
enneth Wade Summerlin II
Authorized Signature
Date: ,. . . �, . , D . ' _

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 4252 Harrys Lane Sherrills Ford NC 28673 County: Catawba
Summerjin &Son LLC
A)
11 L Ada
Owner Kenneth Wade Summerlin
Print Signature
Contractor/agent: Beth Mosteller oitj CI ..".11‘
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,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)1
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 0213 .0243(5), (6))
•
Acknowledgement of Notification
I, Kenneth Wade Summerlin II 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): V\....) SA —A Date: 0 7241;/
Kenneth Wade Summerlin II

bing maps
A 526 S Church St, Charlotte, North Carolina, United States 45 min if 33.9 miles
B 4252 Harrys In, Sherrilis Ford, North Carolina, United States Light traffic (Leave at 12:39 PM)
Via NC- 16 Nr NC- 16
. • • • • • • • •
L , . g _ • . __
A 5265 Church St, Charlotte, North Carolina, United States
1 , Head southeast on W ist St toward S Church St 253 ft
ow 2. Turn right onto S Church St 0 . 2 rni
Take the ramp on the right and follow signs for 1-277 South / US-74
m 05mi
3 • West
At Exit 1C, head right on the ramp for 1 -77 North / US-21 North
el 4 toward Statesville 1 .6 mi
A Moderate Congestion
. .
5 . At Exit 118, head on the ramp left and follow signs for NC- 16 North 26.6 mi, 31 min
.
et 6. Take the ramp on the right 0 . 3 mi
15 7. Turn right onto NC- 150 I E NC 150 Hwy 4a 5 mi
*1 PE Turn left onto Harrys in, then immediately turn right onto
0 . 1 mi
164-' Crabapple Dr
Arrive at Crabapple Dr on the left
9 . The last intersection before your destination is Harrys Ln
_
B 4252 Harrys in. Sherrifis Ford, North Carolina, United States

Latitude Inc 0 . : gitude Fin s - er
Latitude and Longitude are the units that represent the coordinates at geogn
use the name of a place , city, state , or address , or click the location on the mai
Place Name
4252 Hans Lane Sherrills Ford ! NC Find
Add the country code for better results.. Ex : London , UK.
Latitude Longitude
350577810 -81a, 006350
111
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50 foot land in ward corridor access x 10 ft wide = 500 sq ft
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1392 square feet total

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