20221411 Ver 1_Shoreline Stabilization_20221011

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 10/10/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
Monica Wright
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
425 Buckland Land Covd
Address Line 2
City
Eads
Postal / Zip Code
380289
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
TN
Country
United States
Name: * Lex Cathey
Company Affiliation: * LC Cathey Grading
Email: * [e-mail]

Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
4679 Summerside Drive
Address Line 2
City State / Province / Region
Clover SC
Postal / Zip Code Country
29710 United States
A signed and dated copy of the Agent Authorization letter:*
Wright - Agent Authorization Form.pdf 510.75KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Write Shoreline Stabilization
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:*
35.150900
Street Address
3245 lake point drive
Address Line 2
City State / Province / Region
belmont nc
Postal / Zip Code Country
28012 Gaston
Longitude: *-81.024279
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*
Wright - Property Survey.pdf 898.67KB
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.)
Wright Shoreline.pdf 638.27KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Belmont

County: * Gaston
Lake/ river/ ocean adjacent to Wylie
property:
Subdivisions name or site address: *
Reflection Pointe
Include phase/lot number
Directions to site: *
Enter Reflection Point neighborhood off South Pointe Drive onto
Reflection Pointe Blvd, turn left on Lake Pointe Drive and property will
be on your 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 use, house currently under construction
Residential, undeveloped, etc.
6. Property Size .497
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
install close B rip -rap 12" above 570 elevation for shoreline stabilization
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.)
612
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.)
103
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)
only trees with exposed root systems or those 3" in diameter to be
removed
Sketch:
Wright Shoreline.pdf 638.27KB
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
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
I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name: * Lex Cathey
Signature:
Submittal Date: 10/10/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20221411 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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. I 0 -'N- PLAN NO.
PARCEL ID: 2 03 Y � �T
STREET ADDRESS: 73Z Li S LPKc POINT bpi V t
garrON-'A NC DgpJ'2
Please print:
Property Owner: 1) M 1 CA W R! C N i
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
LE -)( CPTA"
(Contractor J Agent)
of L.C, CA�� � RAbl N'A , L L C
(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):
14 2-S `13 U ceLfat jb LA-njp Gov - z� 4 . Tr j
Telephone: 9 Q I— 2 W 9 -• % Ol 0
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: 9 ` / C + Z, O 22 Date:
3 802 2

VICINITY MAP (NTS)
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LINE TABLE
LINE
DIRECTION
DISTANCE
L1
S 68'S7'S8" W
31.18'
L2
S 7126'3B" W
39.60'
L3
S 03.21'37* W
1 11.77'
L4
N 88'21'4 " W
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x• MARK ON
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LOT 106; REFLECTION P01NTE. PHASE 1
PAUL KUSH e
GAL AN KUSH
DO 5099; PG 1885
MB 67; PGS. 63-68
TM #203875
CURRENT SUBIECf
PROPERTIES RIFF6iENCEs:
LOT
105; REFLECTION POINTE, PHASE I
JAMES H. K. A .I.
HEY MAN; ELI -KIN
D9 4164: PG 1741
MB 67; PIGS. 63-68
TM /203874
SURVEY NOTES:
1) THIS PROPERTY SUBJECT TO RESTRICTIONS h EASEMENTS OF RECORD.
2) THE PUBLIC RECORDS REFERENCED ON THIS PLAT ARE ONLY USED TO
VERIFY OR REESTABUSH THE BOUNDARY OF THIS PROPERTY. NO TITLE
SEARCH WAS PERFORMED BY THE STATED SURVEYOR.
3) NO SUBSURFACE OR ENVIRONMENTAL eNESTISATION OR SURVEYS WERE
PERFORMED FOR THIS PLAT_
4) UNDERGROUND ELECTRIC, NATURAL GAS, TELEPHONE, CABE. IR
RIGATION.
ANO/OR ANY UTILITY MAINS AND SERVICE LINES MAY EXIST ON THE
PROPERTY, BUT ARE NOT SHOWN OR A PART OF THIS SURVEY. CALL 811
PRIOR TO DIOGWG OR NEW CON5IRUCTION.
5) A PORTION OF THIS PROPERTY IS LOCATED IN A SPECIAL FLOOD HAIZARD
AREA PER FIRM MAP /3710359100L, EFFECTIVE DATE SEPTEMBER 2, 2015.
TO THE EXTENT SHOWN. FLOOD ZONE AE. 571 BASE ROOD ELEVATION
(BFE).
6) THIS SURVEY IS OF EXISTING PARCEL OR PARCELS OF LAND, Am DOES
NOT CREATE A HEW' STREET OR CHANCE AND EXISTING STREET.
7) THIS PROPERTY IS NOT LOCATED WITHIN 2000 FEET OF A NGS MARKER.
SURVEY PREPARED FOR
MONICA WRIGHT
LOCATED AT 3245 LAKE POINTE DRIVE
IN THE CITY OF BELMONT. 28012
GASTON COUNTY, NORTH CAROLINA
APRIL 7, 2021
EXISTING TAX PARCEL #203874
STATE OF NORTH CAROUNA
COUNTY OF GASTON
I, 'WILUAN T. STAwoRD. ER, CERTIFY THAT THIS PUT WAS DRAWN UNDER MY SUPS V 'ON
FROM AN ACTUAL SURVEY MADE UNDER MY SUPERVISION, (DEED DESCRIPTION RECORDED IN
DEED BOOK 4164, PAGE 1741; THAT THE BOUNDARIES NOT SURVEYED ARE CLEARLY INDICATED
AS DRAWN FROM INFORMATION FOUND IN MB 67; PGS. 63-68; THAT THE RATIO OF PRECISION
OR POSITIONAL ACCURACY AS CALCULATED IS 1.10,000; THAT THIS PLAT WAS PREPARED IN
ACCORDANCE WITH G.S. 47-30 AS AMENDED.
WITNESS MY ORIGINAL SIGNATURE, LICENSE NUMBER AND SEX THIS 7Uh. DAY OF APRIL. 2021
L-I& T. s , 91-
WILLIAM T. STAIFORD. JR. - PROFESSIONAL LAND SURVEYOR
LICENSE NUMBER - L-4378
FIRM NUMBER - P-1799
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BOJ J24. DJ25(oJ, BOJ 4871024(o)
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