20230128 Ver 1_Shoreline Stabilization_20230120

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 1/20/2023
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
J. Kelly Myers
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
P.O. Box 4674
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: * 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 630.32KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Myers 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:*
35.541871
Street Address
232 Camino Real Road
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-9638 US
Longitude: *-80.881729
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 985.41KB
Buffer Form.pdf 1.12MB
Permission to access.pdf 890.29KB
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.)
Shoreline Pics.pdf 21.62MB
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
PID# 4645072358 232 Camino Real Rd. Mooresville, NC 28117
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)
Follow E Wilson Ave and US-21 S to Alcove Rd
9 min (3.7 mi)
Turn right onto E Wilson Ave
1.5 mi
Turn left onto US-21 S
2.2 mi
Use the left lane to continue on Williamson Rd
387 ft
Follow Alcove Rd, Templeton Rd and Camino Real Rd to your destination
4 min (2.1 mi)
Turn left onto Alcove Rd
0.5 mi
Turn right onto Templeton Rd
0.9 mi
Turn left onto Camino Real Rd
0.6 mi
Turn right
Destination will be on the left
0.1 mi
232 Camino Real Rd
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
1.412 acres
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Push down existing rip rap on shoreline. Reshape and re -slope bank,
install matting and install boulder rip rap to refurbish shoreline. 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.)
3.5' below (479.5
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.)
1' above (137 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, no trees removed, minimal disturbance to buffer. Access to
shoreline from neighbor's lot with permission. Neighbor is also having
shoreline project done. Access corridor will 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:
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
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
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Janice Estep
Signature:
Submittal Date: 1/20/2023

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20230128 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

DocuSign Envelope ID: 85C685A0-F4E7-4333-8F8A-6C405527A774
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO.
PLAN NO. PARCEL ID: )---koq 5)7 3 5 g
STREET ADDRESS: •a33a earn no',ea..1 .
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Property Owner: J . ��e.,1 \� ► t Tcs
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
OJC) , of LBO_ 6--one E ec e>1 n,C, uLc.
(Contractor / Agent) (Name of consulting firm)
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):
? O C ox ooccf3v )11e, IBC ail 1 7
Telephone: 10 LI ' Lno
I- 566b
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
DocuSigned by:
0D4864C9F5E0452...
Authorized Signature Authorized Signature
Date;Jan 2, 2023 I 1:56 PM EST
Date;

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Iredell County, North Carolina
December 19, 2022
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
4645072358.000
232 CAMINO REAL RD
Acct 80050885
MYERS PHOENISA
1754 BRAWLEY SCHOOL RD
MOORESVILLE, NC 28117
MYERS PHOENISA+JONATHAN K
MYERS
2648/767 - WD - 20191001
1.412 AC
CAMINO REAL SR1181
R20
1702G00000A009E
$183,710
$17,390
$517,500
$718.600
$0
-ALLCNTY FIRE- -
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
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December 19, 2022
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• Lot #
• Description CAMINO REAL SR1181
•Zoning R2D
• Old Parcel # 1702G00000A009E
• Bldg Value $183,710
• OBXF Value $17,390
• Land Value $517,500
• Total Value $718,600
• Defer Value $0
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Legend
7 232 Camino Real Rd

Full Pond/
Norraf Water Level
Shoreline
1\L AxeeS rem uecJ
fl L Gi 151-u i baat
Lake
(At Full Pond/Normal Water Level)
3.5' bc_►(.7;).; x tt37
40
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Woove X t37'
hoo5e_
Please approximately sketch the following information on this plan, length of shoreiine
(provide dimensions for each itern, such as 10 ft x 100 ft)*:
1. Ail 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
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Page 3 of 3

DocuSign Envelope ID: 85C685AO-F4E7-4333-8F8A-6C405527A774
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The approval is for the purpose and design described in your application. Impacts not indicated in the
app�at�n�aviolation ofthe Buf�rRule, 6�espec�bxvurkshould beprovided inthe app|�atimn.[15ANCAC
Trees are not allowed toberemoved from Zone 1ofthe 8ufh�(x�hin3Oftofthe fuUpond e�vmdon)unless
approved. Excepdon,those �eesthat are severely undermined along the imm^m6|ateshonaknecan beremoved.
Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B.0243(6)]
Benchin�grad�ginthe buf�r�not aDmwed. Excessked�torbanceofground cover O5ANCACO3Q.O243(6�
��im��s����������a���|m�in���un�s��Uya��by the Division. There are limitation on size for decks. [15A NCAC 02B.0243(4) and (6)]
���������mb�mu�i��ean��m�i�i��a�����ae���m���*
xvnrkcm,hdmrshould 6edeyx�6m6.The approved access corhJmvshaUberestored. 5tagin&upmU,construction
�n����n�tbep�J�chan�e f�d��d�hn��t���. �|o���������r
dbchargeomust bemtthe natural ^daxatmnand discharged pdortaentering the buf��directed asdhfuuemr
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
of Notification
i/v/i k^�� '��y`� ' hereby state that ihave been informed mfthe Catawba
"'� _
Riparian Bu�mr"^�=. Any vvorkconducted inthe buffe�not spec0caUystated inthe application and approved
bythe Di�xinnofVVaterResmu�ex(DVVR)'imuviolation and subject tnenforcement. Due diligence w/iUbe
taken such that the construction wU|6ebuUtvv�hinsubstantial comnp|ienceand intent ofthe 4O1VVater
Quality Cmrt|�rationand Buffer Ru|e�the a d |an(s)and oped5naton(s�and other supporbnQ
/--�oocuS'. w«o,
Signature (owner): —'~' ' ' '~ Date:
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I Roomer Hand Tit n Build s ,hereby give permission for
Kelly Myers
and CBC Stone & Recycling, LLC to use the property at
125Nlyers Port Way Mooresville, NC 28117
as an access/equipment staging area for a shoreline proje
232 Camino Real Dr. Moore
_NC 28117
Any areas disturbed by wor1414 be r t ed to original
condition by CBC Stone an
been completed.
Si
D t
12
din after the projel
o

1