20221165 Ver 1_Shoreline Stabilization_20220826

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 8/26/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Thomas D & Julie M Freeman
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
3684 Lake Shore Road South
Address Line 2
City
Denver
Postal / Zip Code
28037
State / Province / Region
North Carolina
Country
United States
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 596.08KB
catawba buffer.pdf 1.16MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Thomas Freeman
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: directions.pdf 302.48KB
Long Lat.pdf 67.33KB
plat.pdf 941.54KB
vicinity lot 68 69.pdf 508.26KB
Latitude: *
35.503720
Longitude: *-80.984510
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 190.48KB
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.)
picture.pdf 706.42KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Dever
County:* Lincoln

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: *
Westport, 3684 Lake Shore Rd S, Lot 68 & 69
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
I077 N / US 21 N toward Statesville, at exit 11 B head on the ramp left and
follow signs for NC 16 N, turn right onto Optimist Club Rd, turn left onto
Woods Ln, turn right onto Natalle Commons Dr, turn left onto NC 16 / N
NC 16 Business Hwy, turn right onto Fairfield Forest Rd, turn right onto
Fairfield Forest R, turn right onto Barker Ln, then immediately turn right
onto Lake Shore Rd
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 with existing dock and wood wall
Residential, undeveloped, etc.
6. Property Size
0.365
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
due to cove wave action, remove existing dock and wall, replace with
Class B rip rap
8. How will the work be done?*
(v From Land
(v 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.)
260
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)
one tree located beside existing dock
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:

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
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.
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: 8/26/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221165 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 E ;V :I TION FORM
PitOPERTY11--GAL DESCRIPTION:
LET NO. 68 & 69 PLAN NO. PARCEL ID : 4604944128
SIREET ADDRESS: 3684 Lake Share Road_South Denver. NC 28037
Please print:
Property Owner: Thomas D luJie M Frcherrtan_. . --
The undersigned, registered property owners of the above noted property, do hereby authorize
Beth Mosteller_ _ --- -.- _ � of Dale & Beth's Lake Use Permit 5eMce
(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 ail standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: [phone] ---- -
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
% . 7#4.sept
0\T•
Thomas D Freeman Jule Freeman
Authorized Signature Authorized Signature
Date: --- 5 r

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 3584 Lake Shore Road South Denver NC 28031 Cotrnty: incon
,00.74Owner Thomas D Freeman
Print Signature
Julie M Freemanf r
Print Signature
Contractor/agent: _ --- Seth Mosteller tigl. 417 delt-1111,Li
Print Signature
The approval is for the purpose and design described in your application. Impacts not indicated in the
appiiCatinn is a violation of the Buffer Rule_ Site specific work should be provided in the application. [ISA NCAC
02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not avowed to be removed from Zone 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. lISA NCAC 02R .0243(6))
Benching, grading in the buffer is not allowed. EXce55iVe 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 Jmitaton 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 duffer. [15A NCAC 02H 05O2 and 15A NCAC 02B .0243 (4), (6), (8)]
5tormwter 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 diffuses or
sheet flow at non-erosive velocities to the lake. {15A NCAC 02B O243(5), (6)]
Acknowledgement of Notification
I, Thomas D Julie M ee p 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 Livision
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(5) and specifrcation(s), and other supporting materials.
Signature {owner}: ipL \ Øate :
Thomas D lull Freeman

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A 526 S Church St,Charlotte,North Carolina,United States
t 1 Head southeast on W 1st St toward S Church St 253 ft
f> 2 Turn right onto S Church St 0.2 mi
® Take the ramp on the right and follow signs for 1-277 South/US-74 0.6 mi
3. West
At Exit 1C,head right on the ramp for 1-77 North/US-21 North
© 4 toward Statesville 1.6 mi
A Moderate Congestion
® At Exit 11 B,head on the ramp left and follow signs for NC-16 North
5 20.1 mi,23 min
Pass Mac's Convenience Stores on the left in 5.2 mi
13 6. Turn right onto Optimist Club Rd 0.5 mi
E'I 7. Turn left onto Woods Ln 0.2 mi
0 8. Turn right onto Natalie Commons Dr 0.6 mi
FI 9. Turn left onto NC-16 Bus/N NC 16 Bussiness Hwy 1.1 mi
I+ 10. Turn right onto Fairfield Forest Rd 1.3 mi
Turn right onto Barker Ln,then immediately turn right onto Lake 0.8 mi
11. Shore Rd S
Arrive at Lake Shore Rd Son the left
12. The last intersection before your destination is Three Wood Dr
If you reach Green Cove Ct,you've gone too far

Latitude and Longitude Finder
Latitude and Longitude are the units that represent the coordinates at ge
use the name of a place, city, state, or address, or click the location on the
Place Name
3684 Lake Shore Road South Denver, NC Find
Add the country code for better results. Ex: London, UK
Latitude Longitude
35.503720 -80.984510
For better accuracy please type Name Address City State Zipcode.

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Side View
$i4
Shoreline
Lake Norman 760 Elevatio ON.
4(At Full Pond/Normal Water Level) /pa%
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4
4 foot base below full pond lake bottom
Top View
Lake
(At Full Pond/Normal Water Level)
oo'` fi'b
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a
85 feet following contour of shoreline
Ala
Shoreline 111,61r`1' �� alMir ram~
ap �,
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Mi&
50 foot land in ward corridor access x 10 ft wide = 500 sq ft
4 foot base below full pond lake bottom x 65 ft along shoreline = 260 sq ft
square feet total 760

One tree tobe removed, remove dock and stabilize shoreline
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