20221626 Ver 1_Shoreline Stabilization_20221116

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 11/15/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
MICHAEL & LINDA LEA ROBERTS
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
1367 NC-108
Address Line 2
City
Rutherfordton
Postal / Zip Code
28139-7325
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
NC
Country
US
Name: * JAY FREEMAN IV
Company Affiliation: * CONTRACTOR
Email: * [e-mail]

Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
PO BOX 155
Address Line 2
City State / Province / Region
Bat Cave NC
Postal / Zip Code Country
28710 US
A signed and dated copy of the Agent Authorization letter: *
signed ROBERTS SEAWALL AGENT
233.75KB
AUTHORIZATION FORM.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
SEAWALL EXTENSION FOR MICHAEL & LINDA ROBERTS
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:*
35.422545
Street Address
186 Lakeridge Road
Address Line 2
City State / Province / Region
Lake Lure NC
Postal / Zip Code Country
28746 US
Longitude: *-82.194159
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*
Freeman -Roberts SEAWALL ALL.pdf 815.78KB
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.)
PHOTOS.pdf 327.01KB
4. Location of the property (where work is to be conducted)

Nearest Town: * Chimney Rock
County: * Rutherford
Lake/ river/ ocean adjacent to Lake Lure
property:
Subdivisions name or site address: *
Lakeridge Rd
Include phase/lot number
Directions to site: *
Head south on Morse Park Trail, Turn right to stay on Morse Park Trail,
Turn left onto US-64 E/US-74 ALT E, Slight left to stay on US-64 E/US-
74 ALT E, Turn left onto Charlotte Dr, then Turn left onto Lake Ridge Dr.
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
0.35
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Extending the existing seawall to stabilize the existing sloped area.
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.)
450
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.)
450
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)
N/A
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:
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.

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:* JAY FREEMAN IV
Signature:
iQ1-12F-,E44
Submittal Date: 11/15/2022

Initial Review
Is this accepted into the review process?* , Yes No
Project Number: * 20221626 Version: * 1
Select Reviewer: * Mitchell Anderson:eads\mlanderson
Select Reviewing Office: Asheville 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

PROPERTY IFOOMMATION
TAX PARCEL a 1606W
AGENT AUTHORIZATION FORM
DEED ■OCW 963 PAGC 383
PROP[ RTY ADDRESS: 186 LAKERIDGE ROAD. LAKE LURE. NC, 28746
Property Owner (As Usted on G►Sj:
MICHAEL W ROIBERT5 AND LINDA LEA RO$ERTS
The undersigned, rr=istrrrd property awnrrs of the above r► ed proj*rty, do htrtby
auth*dte {Name of C*ntract0e1A4*nti 'MY FREEMM IV
of (Nam* of Consuliaq F+rMI CON MAC TOR
to act on PW behalf and take atl actions necessary for the pro[nsinC isswnce and acceptance
of this permit or errtiTratien and arty and all standsrd and speciA conditions ateached.
Property 0wrwr's Address (it diflereni than property abort):
1367 SIC 1CS HWrf RUTHE R FORDTON NORTH CAROLMA 281139
Telephone: (62$) d2$-4715 Email Address_ II roberts@Wlsau[h col
We hereby ctrt+fy the above info motion submmed In this apptk2tion Is tnw and accurat t to
the best of our know IWat-
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