20221648 Ver 1_Shoreline Stabilization_20221122

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 11/17/2022
submitted on: *
Owner Information:
Name: * Jeffrey Martin
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
188 Maple View Drive
Address Line 2
City
Troutman
Postal / Zip Code
28166
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
North Carolina
Country
United States
Name: * Donna P. Hrko
Company Affiliation: * Lancaster Custom Dock and Lift Systems, Inc.
Email: * [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
1156 Perth Road
Address Line 2
City State / Province / Region
Troutman North Carolina
Postal / Zip Code Country
28166 United States
A signed and dated copy of the Agent Authorization letter:*
Martin Signed Agent Authorization Form.pdf 139.75KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Martin Shoreline Refresh
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:*
35.662415
Street Address
188 Maple View Drive
Address Line 2
City State / Province / Region
Troutman NC
Postal / Zip Code Country
28166-8807 US
Longitude: *-80.934187
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*
Martin Detailed Site Plan and Misc
1.31MB
Documents.pdf
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.)
Martin Shoreline Photos.pdf 1.38MB
4. Location of the property (where work is to be conducted)

Nearest Town: *
County:*
Lake/ river/ ocean adjacent to
property:
Subdivisions name or site address: *
Troutman
Iredell
Norman
Wildlife Bay Ph 2, Lot 100 188 Maple View Drive, Troutman 28166
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 42, Left onto Main Street/US 21 NB, Left onto
Wagner Street/Perth Rd, Right onto State Park Road, Left onto Wildlife
Bay Road, Right onto Sierra Woods Drive, Right onto Maple View Drive.
Property is on the right in cul-de-sac.
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 .9 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shoreline refresh for stabilization and erosion control.
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.)
2,934 SF
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 sf const.
corridor
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)
None
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

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
a I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Donna P. Hrko
Signature:
Submittal Date: 11/17/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20221648 Version: * 1
Select Reviewer: * Andrew Pitner:eads\ahpitner
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: 100
STREET ADDRESS:
188 Maple View Drive
Troutman, NC 28166
Please print:
PLAN N0:
Property Owner: Jeffrey Martin
Property Owner:
PARCEL ID: 4720515615
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko , of Lancaster Custom Dock and Lift Systems, Inc.
(Contractor/Agent) (Name of consulting frm)
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 alcove):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Author' ed Mnature Authorized Signature
11-3-2022
Date
Date

12. Please approximately sketch the following information on this Plan and provide di►nensions or
each item; f
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c, Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e• Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake
(At Fall Pond/ Normal Water Level)
Full Pond/ Normal Water Level
Shoreline
Plan View
FORM: SSGP 02-2017
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Page 3 of 4

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Side View
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FORM: 55GP 09-2020 Page 5 of 6

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Iredell County, North Carolina n, n,,, —1,-. I A

Iredell County, North Carolina
November 14, 2022
MARTIN AERIAL PHOTO OF PROPERTY
' = 135,4932413898031 ft
Tax Map information
• PIN
• Address
• Account #
• Tax Owner
• Mailing Address
• GIS Owner
• Deed Info
• Tax Acres
• Lot #
• Description
• Zoning
• Old Parcel #
• Bldg Value
• OBXF Value
• Land Value
• Total Value
• Defer Value
• Tax Districts
4720515615.000
188 MAPLE VIEW DR
Acct80094989
MARTIN JEFFREY ALBERT
1.88 MAPLE VIEW DR
TROUTMAN, NC 2816E
MARTIN JEFFREY A-FeRONWEN A
2938 / 2258 - WD - 20220810
0.961 AC
100
WILDLIFE BAY P2 PB32-155.156
R20
$216,070
$22,800
5385, 000
$623,870
50
-ALLCNTY FIRE- -
[R1.1.DE].i
MAP FOR REFERENCE ONLY
NOT A LEGAL DOCUMENT
Iredell County. North Carolina makes no claims and no
warranties. expressed or implied, concerning the validity or
accuracy of the GIS data presented on this map.
Print map scale is approximate.
Critical layout or measurement
activities should not be done using
this resource.

TAVi1BA RlPARlA1V RLjFF��TION
Project Narnefaddress. r
Y Dr•
1it� County: �rede 1 �
Owner: re r
Pri nt�,_J
Contractor/agent: �] � C 1 e� Sign
'� T
Print
I ■ signature -
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Suffer Rule. Site specific work should be provided in the application. 15A
NCAC 02H .OS06 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 all j1SA NCAC 02B .0243(6)]
Benching and grading in the buffer is not allowed. Excessive disturbance of ground c
.0243 (6)] over. j15A NCAC 2$
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 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. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (g)]
Stormwater cannot be piped or channeled for direct discharge to the fake. 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, f 15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
I' e` GL''' +i 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 a n a approved
by the Division of Water Resources IR), is a violation and subject to enforcement. Due diligence vrili 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: J LJ

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