20230091 Ver 1_Shoreline Stabilization_20230117

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 1/16/2023
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
David Williams
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
80 Winay Terrace
Address Line 2
City
Long Valley
Postal / Zip Code
07853-3575
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
NJ
Country
US
Name: * Donna P. Hrko
Company Affiliation: * Lancaster Custom Dock and Lift Sytems, 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: *
Williams Sighed Agent Authorizaiton
149.O1KB
Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
Williams Boat Ramp Maintenance
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:*
35.540232
Street Address
152 Sandy Shore Drive
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-7499 US
Longitude: *-80.905694
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*
Williams Boat Ramp Site Plan and Misc.
Docs.pdf
Please use the diagram at the link below:
l.I5MB
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.)
Williams Google Earth Boat Ramp.pdf 3.76MB
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: *
Surf Side Estates Lot #9
Include phase/lot number
Directions to site: *
From I-77 NB, Exit 35, Left onto Brawley School Road, Left onto Isle of
Pines Drive, Right onto Harborview Place. Left onto Sandy Shore Drive.
Property is on the right.
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
.571 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Repair existing spalling concrete boat ramp with marine hog slat overlay.
Slats will be anchored with re -bar.
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.)
800 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 construction
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:*
Signature:
Donna P1 Hrko
Submittal Date: 1/16/2023

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20230091 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: 9
STREET ADDRESS:
152 Sandy Shore Drive
Mooresville, NC 28117
Please print:
PLAN NO:
Property Owner: David Williams
Property Owner:
PARCEL ID' 4635361914
The undersigned, registered property owners of the above noted property, do herebyauthorize
DONNA P HRKO , of LANCASTER'S CUSTOM DOCK & LIFT SYSTEMS,
INC.
(Contractor/Agent)
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptanceof this
permit or certification and any and all standard and special conditions attached.
Property Owners Address (if different than property above):
80 Winay Terrace
Long Valley, NJ 07853
Telephone: [phone]
We here
Authoriz(
12/1/22
Date
the above information submitted in this application is true and accurate tothe
Authorized Signature
Date

THE INFORMATION CONTAINED IN THIS DRAWING 1S THE SOLE PROPERTY OF LANCASTER'S DOCK& LIFTS SYSTEM INC.
ANY REPRODUCTION IN PART OR AS A WHOLE WITHOUT THE WRITTEN PERMISSION OF LANCASTER'S DOCK & LIFTS SYSTEM INC. IS pROHIBITED.
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ISSUE
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11-29-22
Dave & Julie Williams
152 Sandy Shore drive
Lancaster Custom Dock and Lifts
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Mooresville, N.C.
1156 Perth Road Troutman
North Carolina

(At Fi
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Side View
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10 ft. bank
height
Side Vi _r
-1 ft, below full pond water level 4 ft, above full pond water level
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2 ft- additional clearing
. 'If necessary
FORM: SSGP 02-2017
Page 2 of 2

PHYSICAL SURVEY
FOR
DAVID WILLIAMS
& JULIE WILLIAMS
LOT 9 OF SURFSIOE ESTATES
Q 152 SANDY SHORE OR, MOORESVILLE, NC
DAVIDSON TOWNSHIP - IREDELL COUNTY, NC
SCALE: 1" - 50'
DEDMON SURVEYS
CHUCK PWVEY, PLS83752
ROBERT DEDMON, PLS#3999
3704 NC HIGHWAY#16 NORTH
P.O. BOX 494 - D£NVER, NC 2,8037
PHONE: [phone]
FiRM#C-04S3
acu
L�7a1
I CERTIFY THAT TFIU FLAT WAS SURVEYW AND DRAWN
FROM AN ALTt SURVEY MADE LNDER W
SUPERVISION DB 2423, P6 1745; PB 7, PG la; THAT
90UHMM NOT SURVEYED ARE DRAWN FROM DB .
PG ; THAT THE RAM OF PRECISION DMEEDS
100000; THAT TINS PLAT MEETS THE REWR Dn
OF THE STANDARDS OF PFOC"M FOR NO (21
NCAC56BOO) WRWE55 MY OFFICK SEAL
-AND
SHQNXTIJW THRA 3RD AAY OF MAY, AD I=.
�7 ,
SIM. BY: WJ I DRAIN: KAJ I JG" SAilOsill
VICINITY MAP q
AIARBORVTEW ,
LY
SANDY
SHORE OR
SITE x
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ar��ON�TRS� •�•
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60 0 60 100 150
GRAPHIC SCALE — FEET
3.1V END:
BOUNDARY LINE
=rrARY SEWER UNE
NATL]RAL GAS LINE
UNDERGROUND POWER
�MMn�.n OVERHEAD UTILITIES
_ T UNDERGROUND TELFPNONE
WATER a� FENCE OYPE UNE
NOTED)
CP - COMPUTED POOR (UNMARKED)
R/W - RIONr-OF--WAY
E/P - EDGE OF PAVEMENT
C/L CE TERUNE
- LMLfFY POLE
LOT 10
MB 7 PC 18
CO.,.,
SCAT RAMP
III
BUOAAT I —NOTES:
• PROPERTY RAY' BE SUBJECT TO PoECORaEO OR JE7 Sm
UNRECORDm RIGHTS OF VIA OR EASEMENTS RkYP
N(yT 0@SFRySp
10' DR %%GE & UFL.ITY EASEMENT MAY DI ST ALONG ALL UW I NdS
' UTb ALTLbSAEPRIORBWZONN
am
CONSSRUCIION.
• OILIEN5gNS OF ALL IL1FRODEV MEWLTS SHOWN ON
EMS PLAT SFIDLILO NOT BE SCALEa OR RElJfD
UPON FOR DESIGN OR OONSIRUCUON Wrm"
A FO D YEAFIMM OF AlL DRjEHSjDNS.
DmnAL COPIES OF TNLS FILE ARE FOR ONCE
' DAILY AM WAY NDP eE u m POR GFEAON WOW.
• ALL UNBEtOROUNID UnUTIES ARE NOT MWN HEREON.
• ALL PINS WERE FOUND 0%Tm AS SHOFTN Umms NOTED OUumsE.
DEDMON SURVEYS
Rol
A`k _
Ex. C7 60,��o
LOT 9
0.571 AC 4--
'NOTE: IMPROVS AUffS
EXIST ON TKIS LOT THAT
ARE NOT SHOWN ON THIS
SLR?VEY.
� so' euPFETR
APPRDX. FEMA FLwi) IX. CONCRETE
,� L.KE PER GIS LAONIFI4TTr
ACTUAL 7!q`6-MUR
UNE PEfVFELD L0ClLilON
/ 4/27/20E2
�f
P M CONCREi�E vS+�s
MONIMEflT 7
LOT 8 & PART OF 7
MB 7 PG 18
D8 1236-675
::NORMAN ~ N
MT Doom, pm OR GFIQY r
� auR1E1' L'LATr W
' A PGRFION OF TINS PROPERTY IS LOCATFD IN A 100 YEAR FLOOO PLAJH
AS DESIGNATED 6Y FIRM PANEL 046M
EFPECTNC LUTE: 6/16/M9
Cause
I Bearing
Distance
L1
I S 82'56 00 W
32.40
L2
N 82'5110 W
80,74
L3
N 3R'Od OD W
20.00
Curve I Radius I Length Chord Chord Bear.
C1 175.50 5.39 25.36 S 84 5O 3S E

lredell County, North Carolina
January 13, 2023
Tax Map information
• PIN
• Address
• Account ri
• Tax Owner
• Mailing Address
•
• GIS Owner
• Deed info
• Tax Acres
• Lot #
• Description
• Zoning
• Old Parcel u
• Bldg Value
• OBXF Value
• Land Value
• Total Value
• Defer Value
• Tax Districts
4635361914.000
152 SANDY SHORE DR
Acct80035545
WILLIAMS DAVID M
80 WINAY TER
LONG VALLEY: NJ 7853
WILLiAMS DAVID M+iULIE B
2423 / 1745 - WO - 20160602
0 LT
9
SURFS1DE ESTATES PB7-18
R20
1702G02000A009
`b480,880
$20,260
$425,000
$925,140
50
-ALLCNTY FIRE- -
Williams Boat Ramp Aerial View
MAP FOR REFERENCE ONLY
NOT A LEGAL DOCUMENT
Iredel County, North Carolina makes no claims and no
warranties, expressed or implied. concerning the Validity or
accuracy of the GIS dale presented on this map.
Print map scale is approximate.
Critical layout or measurement
activities should not be done using
this resource.

Project l
owner:
Contract
The "FIJIUvdi is Tor the purpose and design described in your application. Impacts not indicated
application Is a violation of the Buffer Rule. Site specific work should be provided In the ap lication. the
NCAC 02H .0506 and 15A NCAC 02B .0243(8)] p [15A
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 allowed. [15A NCAC 02B 0243(6
Benching and gradin 71
.0243 (6)1 gin the buffer is not allowed. Excessive disturbance of ground cover. [1SA NCAC 02B
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. [1.5A NCAC 023.0243(4) and (5)j
Work to be conducted from land must indicate an access and indicate any d. The trees that are to be remove
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, constructive
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)1
Storrnwater cannot be piped or channeled for direct discharge to the lake. 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), [Bjl
Acknowledgement of Noty1cadon
!f 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 B r Rule , the approved la j and specification(s), and other supporting
materials.
Signature (owner);
Date:

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