20230031 Ver 1_Shoreline Stabilization_20230109

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 12/24/2022
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
JANIS BLACK
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
144 Sagemore Road
Address Line 2
City
Mooresville
Postal / Zip Code
28117
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
NC
Country
US
Name: * TAMARA HAGER
Company Affiliation: * LAKE PERMIT LLC
Email:* [e-mail]

Phone Number:*
Mailing Address:*
[phone]
(xxx)xxx-xxxx
Street Address
PO BOX 5335
Address Line 2
City State / Province / Region
MOORESVILLE NC
Postal / Zip Code Country
28117 US
A signed and dated copy of the Agent Authorization letter:*
BLACK AUTH.pdf 166.12KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
BLACK
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: BLACK SURVEY.pdf 126.37KB
Latitude:*
35.619817
Longitude: *-80.886904
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*
BLACK SKETCH.pdf 100.96KB
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.)
BLACK PICS.pdf 237.2KB
4. Location of the property (where work is to be conducted)
Nearest Town: * MOORESVILLE
County: * Iredell
Lake/ river/ ocean adjacent to NORMAN/CATAWBA
property:

Subdivisions name or site address: *
CRESENT LAND & TIMBER LOT NUMBER 20
Include phase/lot number
Directions to site: *
FROM MARSHALL STEAM STATION TRAVEL LEFT ON 150 FOR
250 FT, LEFT ONTO PERTH RD 4.2 MILES, RIGHT ONTO
SAGEMORE 1.4 MILES, DESTINSTION ONF RIGHT 900 FT.
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 .75
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
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: *
0
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
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.)
0
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 BY BARGE
Sketch: BLACK SKETCH.pdf 100.96KB
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
o I intend to electronically sign and submit the Shoreline Stabilization online form.

Full Name:* JANIS BLACK
Signature:
Submittal Date: 12/24/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20230031 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

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The approval is for the purpose and design described In your application. lmpec4Cs not indicated In the
application Is a vfclatiQn afthe Bar Rule. Site spectrfc work should be provided in the application. 115A 1JCAC
02H .0546 and 1SA NCAC 02B .0243{8j1
Trees are not allowed to be removed from Zone 1 of the Buffer {within 30 ft of the full pond elevation), unions
approved. Btccepton, those trams that are severely undermined fined along the immetffate shore) ine can be removed.
Minimal shaping and sloping ski ng the immediate !barmen!' rs allowed. 115A NCAC 023.0243(5fl
&enchfr+g, grading fn the buffer is not allowed. Excessive dirturbanoe of ground =vair. [].5A NCAC Oae _0243 td)j
aaach es, impervious patios, trade.rvia ua waikuays, etc. are not allowed inthe buffer unless specifically approved
by the Division. There are Ifmitatton on sEze$nr decks. (15A NCAC 02E1 .074314) and ())
'Rork to be conducted from land must Indicate an access aMd Indicate ar,v trees Chia are is be removed. Tne
veer* corridor should be described. The approved acress corridor shall be restored_ StagIng, spoil, construction
cagier must be outside the buffer. (15A NCAC 02H _0502 and 15A i'ECAC CO2B _0242 ;41, (S), (C)
Storm water `annot as piped or channaiad for direct discnlr=a to the lake. Ali constructed armwe:.
r
discharges fuSt be at the naturel elevation and discharged prior to arrtering the buffer directed as defuse or
shag: flow Et non .aroshre velodties to the lake. (15A NCAC 028 .0243(5), IS)]
cimawiedgmentof Notification
ALA.( t , r ereby state that i have been informed of the Catawba
Rfaa; an Bufte,r Rule. Any work mnductedintile buffer, not specrzfaliy stated in he application and approved
by the Dtvielars of Wetter Resources (DWR), it a violation end subject to snfarcernarrt Due diligence will be
taken such thettha cansruttlen wit) be bufitwre iln ruhstarntlal campliance and Irtterrt ctthe 401 Water
Quality Certiffcat1cr and Buffer Rufes, the approved plants} and ape ica+5on{sl, and other supporting
rnat.edais.
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LAME NORMAN
( MILL BRANCH)

Full Pond/
Norrnr$
Sharelfne
Lake
lAt Full Pond/Normal WabarL,evel'
4lap'
fb EES R
LAW ( LD1JF
Qt;.G4- JA16 . a-• 15 c
Please appraxlmately sketch the fallowing inforrnatian on ttiis plan (Provide dimensions for each
tem, such as 10 i t x 100ft) *:
1_ All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/Normal Water Level elevation
3- Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 1O-2013
Page 3of3

From: Tamara Heger temerehaae•s3ciouo wrn B
Subject: Snorslirre
Direr: December 8 2022 et 9-05 PM
To: TAMARA RACER nagereiakeperrm com
Tamara Hager
704-575-2227
The information contained in this message is confidential and is intended solely for the
recipient(s) identified above. If you are not the intended recipient or there are any
problems. please notify the sender immediately. The unauthorized use, disclosure, or
copying of this message is strictly forbidden and may subject you to legal action.

From. Tamara Hager [e-mail]
Subject Shoreline
Date Dec 8, 2022 at 9:04:54 PM
To Tamara Hager idgereiaKepermit.com
1,41 Z'
Tamara Hager
704-575-2227
The information contained in this message is confidential
and is intended solely for the recipient(s) identified above. If
you are not the intended recipient or there are any problems,
please notify the sender immediately. The unauthorized use,
disclosure, or copying of this message is strictly forbidden
and may subject you to legal action.

Full Pond/
Norrnr$
Sharelfne
Lake
lAt Full Pond/Normal WabarL,evel'
4lap'
fb EES R
LAW ( LD1JF
Qt;.G4- JA16 . a-• 15 c
Please appraxlmately sketch the fallowing inforrnatian on ttiis plan (Provide dimensions for each
tem, such as 10 i t x 100ft) *:
1_ All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/Normal Water Level elevation
3- Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 1O-2013
Page 3of3