20200640 Ver 2_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 1/3/2023
submitted on: *
Owner Information:
................................................................................................................
Name: * R. Graham Fizer III
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
166 Hazelton Loop
Address Line 2
City
Mooresville
Postal / Zip Code
28117-6854
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
NC
Country
US
Name: * Janice Estep
Company Affiliation: * CBC Stone & Recycling, LLC
Email: * [e-mail]

Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
638 Oakridge Farm Hwy
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28115 United States
A signed and dated copy of the Agent Authorization letter:*
Agent Form.pdf 633.05KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Fizer Shoreline
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:*
35.571212
Street Address
166 Hazelton Loop
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-6854 US
Longitude: *-80.880266
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*
Site Plan.pdf
Buffer Form.pdf
Please use the diagram at the link below:
928.36KB
1.07MB
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.)
Shoreline Pics.pdf 28.21MB
4. Location of the property (where work is to be conducted)

Nearest Town: * Mooresville
County: * Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: *
Directions to site: *
610 E Center Ave
Mooresville, NC 28115
Lot 10 Regency Lake Village
Include phase/lot number
Head south on Evergreen St toward E Center Ave
14 sec (197 ft)
Turn right onto E Center Ave
2 min (0.5 mi)
Turn left onto S Church St
1 min (0.4 mi)
Take NC-1100/Brawley School Rd to Canvasback Rd
11 min (4.6 mi)
Turn right onto E Wilson Ave
1.5 mi
Continue onto NC-1100/Brawley School Rd
1.0 mi
Continue straight to stay on NC-1100/Brawley School Rd
2.2 mi
Take Regency Rd to Hazelton Loop
3 min (0.8 mi)
Use the left lane to turn left onto Canvasback Rd
0.2 mi
Turn left onto Regency Rd
0.4 mi
Turn right onto Hazelton Loop
Destination will be on the right
0.3 mi
166 Hazelton Loop
Mooresville, NC 28117
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
0.65 acres
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Remove existing, heavily damaged wood wall. Remove undermined and
fallen trees on immediate shoreline to properly stabilize bank. Install an
Alan Block wall to replace old wall. Install TN Crab Orchard steps for
lake access.
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.)
4' below (704sf)
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.)
1' above (176 sf)
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)
Grass buffer, remove undermined and fallen trees on immediate shoreline,
minimal disturbance to buffer. Access corridor to be restored to original
condition.
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.
o 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
a I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Janice Estep
Signature:
ct¢rr cirrf eirner+t
Submittal Date: 1/3/2023

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20200640 Version: * 2
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

LOT NO. I D
AGENT AUTHORIZATION FORM
PLAN NO. , PARCEL ID:
STREET ADDRESS: 16 6 /7` -t- Z-00JI0
AIC Z5r17
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby, authorize
E:5A,—D Of
(Contra d-or I Agent) (Name of consulting firm) 'J�_a
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):
Telephone: _qp4 - � 5b -..S-qu R
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
ZZ11—
Authorized Signature
Date: LZq1 -Z-2-
1 1
Authorized Sgriiature
Date: 1. Z- J'Z- 2-

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Iredell County, North Carolina
December 29, 2022
Tax Map Information
• PIN 4646089001.000
• Address 166 HAZELTON LOOP
• Account it Acct 80064947
• Tax Owner FIZER RICHARD GRAHAM III
• Mailing 166 HAZELTON LOOP
Address
• MOORESVILLE, NC 28117
• GIS Owner FIZER RICHARD G III+MARIA K
• Deed Info 2639 / 1312 - WD - 20190821
• Tax Acres 0.65 AC
• Lot # 10
• Description REGENCY LAKE VILLAGE BLKA SHT2
PB10-59-59A
• Zoning RA
• Old Parcel# 1702KO7000A010
• Bldg Value $874,260
• OBXF Value $68,780
• Land Value $291,500
• Total Value $1,234,540
• Defer Value $0
• Tax -ALLCNTY FIRE- -
Districts
0
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.
T" = 58.531950125681234 ft
Print map scale is approximate.
Critical layout or measurement
activities should not be done using
this resource.

Iredell County, North Carolina December 29, 2022
44
168
-P
60
IL
156
10
It,
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fi
1" = 58.531950125681234 ft
Tax Map Information Print map scale is approximate.
•PIN 4646089001.000
• Address 166 HAZELTON LOOP Critical layout or measurement
•Account # Acct80064947 activities should not be done using
• Tax Owner FIZER RICHARD GRAHAM III this resource.
Mailing 166 HAZELTON LOOP
Zdress MAP FOR REFERENCE ONLY
• MOORESVILLE, NC 28.117 NOT A LEGAL DOCUMENT
• GIS Owner FIZER RICHARD G III+MARIA K
• Deed Info 2639 / 1312 - WD - 20190821 Iredell County, North Carolina makes no claims and no
• Tax Acres 0.65 AC warranties, expressed or implied, concerning the validity or
• Lot# 10 accuracy of the GIS data presented on this map.
• Description REGENCY LAKE VILLAGE BLKA SHT2
PB10-59-59A
• Zoning RA
• Old Parcel # 1702KO7000A010
• Bldg Value $874,260
• OBXF Value $68,780
• Land Value $291,500
• Total Value $1,234,540
• Defer Value $0
• Tax -ALLCNTY FIRE- -
Districts

Full Ford/
Normal Wa er Level
Shoreline
La ke
(At Pull Pond/ Normal Water Lever
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Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for ecich item, such as loft x 100 ft)*:
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 10-2013 Page 3 of 3

�CA-TAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Narrieladdress:JLbU tZed
Owner:
Print Signature
Contractor/agent: C Gel SA-onz...L-&cLAc Yr, -L-r. AA ro
Print
The approval is for the purpose and design described in your apphc�ation. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application.. [15A NCAC*
02H .0506 and ISA NCAC 029,0243(8))
Trees are not allowed to be removed from Zone I 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. [15A NCAC 02B.0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 028.0243 (6))
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 028.0243(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 buffer. [15A NCAC 02H .0502 and 15A NCAC 028.0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges m ust 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. [15A NCAC 02B .0243(5), (6)]
Admawledgement of Notificadon
Cq, -Z CL 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 Division 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(s) and specification(s), and other supporting
materials.
Signature (owner): Date: Z-Z'

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