20230228 Ver 1_Shoreline Stabilization_20230209

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 2/7/2023
submitted on: *
Owner Information:
Name: *
Email: *
Phone Number:
Mailing Address: *
John McClelland
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
201 Keats Road
Address Line 2
City
Mooresville
Postal / Zip Code
28117-8770
Is there an agent working on the project? * Yes
No
Agent/Consultant Information
State / Province / Region
NC
Country
US
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:*
McClelland Signed Agent Authorization.pdf 139.92KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
McClelland Shoreline Stabilization
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:*
35.547624
Street Address
201 Keats Road
Address Line 2
City State / Province / Region
Mooresville NC
Postal / Zip Code Country
28117-8770 US
Longitude: *-80.874575
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*
McClelland Detailed Site Plan and Misc.
1.15MB
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.)
McClelland Photos.pdf 1MB
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: *
Lots #1 & #2 Henry Moore Kelly Subdivision
Include phase/lot number
Directions to site: *
From I-77 NB Exit 33, Left onto Williamson Road, Left onto Alcove
Road, Right onto Templeton Road, Right onto Henry Lane, Right onto
Keats Road. Property is on the left at the end of the 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
1.01 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.)
405 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: 2/7/2023

Initial Review
Is this accepted into the review process?* Yes No
Project Number: * 20230228 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: 201 PLAN NO: PARCEL ID: 4645293497
STREET ADDRESS:
201 Keats Road
Mooresville, NC 28117
Please print:
Property Owner: John McClelland
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Flrko , of Lancaster Custom Dock and Lift Systems, Inc.
(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 Owners Address (if different than property above);
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Aut ■•' ized Signature
12 r2-2022
Authorized Signature
Date Date

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
r
Lake
(At Full Pond/ Normal Water Level)
Full Pond/ Normal Water Level
Shoreline
Plan View
Lake
iA! FuAI Pond/ NorrnA Water Level)
Full Pond/ Normal Water Level
narreTne .r.
2 ft. r 150 ft.
additional clearing
• if necessary
Plan View
Existing Dock
x7 ft
3 ft x 150 it
Below full Dona NWL
dffn 150ft
Above lull pond/ NWL
E
LD_E
dn.rnnerrt of n�irat..ientai quaary
North Carolina Department of Environmental Quality 1 Division of Water Resources
512 North Salisbury Street l 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

Lake
(At Full Pond/ Normal Water Level)
.4.
vosr
Side View
10 ft. bank
Side Vi
FORM: SSGP 02-2017
c
0
13_
LL.
3 ft, below full pond water level 4 ft. above full pond water level 2 ft. additional cleanii
If necessary
,o
\''.
p ! 1 —..\• i 1 i 7. - - — Z • e2 i ii El il
.
1 i i
, / • i 1-- - 1
1 1
Page 2 of 2

D+S
N ALLEN & ASSOCIA S, P. A.
"Since 1971"
Commercial " Residential * Mortgage Surveys * Multi -Family
Construction Staking * Subdivision Design * Topographical
131 Crosslake Pork Drive - Suite 102 * Mooresville * NC * 28117
[phone] [phone] Fax
I, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded in deed book 686_
plat book 10p-Page 30 and/or
was prepared in accordance with the Generalthat e Statutes ofratio of eNorth Carolina,
a of na,cision is l':'1 CCChapter 89C. map
my hand and seal on the 25 day of AUGUST
A.D. 20 21 .
CURVE TABLE
GTH
CURC7VE !_ RADIUS ING CHORD1
50.00' 1 4311' 1 N 32 511''56* W ! 41. 9'
LOT 3
MARION A.
HAMILTON
1057/809
1
w
m
WOOD
FEN a£
BENCHMARK
TOP OF PIPE
- 781.99'
LEGEND
gal = P.P. - POWER POLE
DP = COMPUTED PANT
E.T.P. = !DUSTING IRON FOUND
LP.. = t4 WEAR SET
R/W - RIGHT-OF-WAY
WILLIAM M
UPDATED: 11/22/2021 :{yam .�:
ADDED TOPOGRAPHY �•yf y' S Q �d
,11/ +94✓l7'1 FM1 e, ok%
**LAKE
NORMAN**
WOOD
Dock/
RAMP
$z5.257ga w
�9ao `�
,4,
, --1- wok
__-.--768`r-_ _----�
AMR 50�R_ "!-
780
-5' FRONT
W = WELL R/w - -
)'yT = LP - uGHT POLE
0' 25' 50' 1O0i'
u
SCALE 1N rEE
AIRS
COVERED
WOOD
AD NgBifoS
760 CON1OI:R LOCATED
PER ACTUAL FIELD
SURVEY
ACCESS' LOT
MULTIPLE OWNERS
OF KE'LLYS COVE
2784/14
ay
CONC
IA0NOMENT
T
NOTES
THIS PROPERTY MAY BE SUBJECT TO
ANY EASETdEM AND/OR RIGFl7S-OP-WAY
OF RECORD.
AREA COMPUTED BY THE CAORDNA,E
METHOD.
EXISTING 760' & 761' CONTOUR ELEV-
ATION BASED ON LAKE NORMAN LAKE
LEVEL AT COWAN'S FORD DAM (READING
ON 6/13/2021) ELEVATION: 737.3'
OVERHEAD POWER
NO GRID MONUMENT FOUND WITHIN
2000 FEET.
PROPERTY ZONW IREDELL; R-28
201 KEATS ROAD scrok:xS SHOWN PER zcHisa
LOT 1 & 2 HENRY MOORE KELLY SUBDIVISION
OVERHEAD
POWER
KEATS RD
(60' R/»)
PHYSICAL SURVEY
OF s}
T)
2)
3)
SCALE 50' DAVIDSON TWSP.. IREDELL Co., N.C.
ACQUIRED BY: JOHN AND DEBORAH MCCLELLAN❑
FIELD BOOK: 504-Y
F1LE HENRY MOORE T-2.DWG
nc F1LE
EAX MAP NR 4845293497

lredell County, North Carolina
• Address
• Account #
• Tax Owner
• Mailing
Address
• GIS Owner
• Deed Info
• Tax Acres
• Lot t
• Description
•2onfng
• Old Parcel #
• Bldg Value
• ❑BXF Value
• Land Value
• Total Value
• Defer Value
• Tax Districts
Tax Map Information
• PIN 4645293497.000
201 KEATS PO
Acct80086330
MCCLELLAND JOHN M
201 KEATS RD
MOORESVILLE, NC 28117
MCCLELLAND JOHN M+DEBORAH
L
285611722 - WO - 20210930
LT
1+2
HENRY MOORE KELLY P810-24
R20
1702G040000001
$252,810
$16,470
$400, 000
S669,280
$0
-ALLCNTY FIRE- -
McClelland Overview
1
iRE I)[ I.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 G IS data presented on this map.
February 3, 2023
Print map scale is approximate.
Critical layout or measurement
activities should not be done using
this resource.
ExisH n5
rx.Y-)s.how n IS
evn& ed.

CATAWBA RIP AN BUFFER N FICAT
N FO
Proja Nemeladdress:
ownero
t
Contractor/agent:
001 l
Viiknt P l
5i nature
purpose
The approval is for the and design described In your application. i
' Suffer Rule. Site specific work should
NCAC 02H .0506 and 15A NCAC 025.0243(8)1
application Is a violation of theImpacts not indicated in the
be provided In the application. [15A
Trees are not allowed to be removed from Zone 1 of the B
aped. Exception. those trees that are severelyoffer (within 30 ft of the full pond elevation), unless
removed. Minimal shaping and sloping along the immediate shoreline along
the immediate shoreline can be
Benching and grading in the buffer is not allowed. Excessive allowed. [15A NCAC 0ZB .0243(6)1
.0243 {6�jve disturbance of ground cover. (15A NCAC 028
Beaches, impervious patios, impervious
walkways,
in
approved by the Division. There are limitation onize for decks. [15AlNCAC 02B lowed the buffer unless specifically
Work to be conducted from land must indicate an access and indicate .0243(4) and (6)]
work corridor should be described.any trees that are to be removed. The
material must be outside the buffer. The15A NCAC 02 050and 15A Noved access corridor il be
restored. Staging, spoil, construction
CAC 0$B .0243 (4), (6), (8))
Stormwater cannot be piped or channeled for direct discharge to the lake. All
discharges must be at the natural elevation and discharged prior to enters constructed irnwetor
� the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (5)]
iowded'deoraeftofNotcrtlo r
i,
Print
Riparian Buffer Rule An hereby state that l have been informed of the Catawba
Y 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
taken such that the construction will be built within substantial compliance and intent of thei402. will be
Quality Certification and Buffer Rules, the a 441 Water
materials. approved plans) and specification(s),ond other supporting
Signature (owner):
Date: /01.5-2,2

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