20150281 Ver 1_Shoreline Stabilization_20150318

State of North Carolina
2 0 1 5 0 2 8 1 Department of Environment and Natural Resources
DDivision � � of Water Resources .1
s,- " - -- 15A NCAC 02H.0500 — Water 5 ahty Certification, Shoreline Stabilization
Division of Water Resources
FORM. SSGP 10 -2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center „L D
Raleigh, NC 27699 -1617 ' IR 1 2015
I. Applicant Information [15A NCAC 02H 0502(a)] 401 & suFiz ,,� ,�A;R s
1 Owner Information
Name- Steven J Rotman
Mailing Address- 150 Hampshire Drive
Mooresville, NC 28115
Telephone Number 704- 662 -4983 cell Fax Number 704- 664 -0801
E -mail Address. srotman @amdiemold com
2 Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here
http / /www saw usace army mil/ Portals /59 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM pd f) must be attached if the Agent has signed this application form
Name
Company Affiliation
Mailing Address
Telephone Number: Fax Number -
E -mail Address
Person to receive the Certification Approval
II. Project Information [15A NCAC 02H .0502(a) & (b)]
1 Attach 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
2 Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM SSGP 10 -2013 Page 1 of

etc ), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors You may use the diagram provided at the end of this
application form
3 Attach a photograph of the shoreline/ buffer proposed to be stabilized (Include a scale
4.
of some sort- a yard stick, shovel handle, etc )
Location of the property (where work is to be conducted)
County Iredell Nearest Town Mooresville
Subdivision name or site address (include phase /lot number) 5 Big Indian Loop- 577
577- Big Indian Loop Mooresville NC 28117
Directions to site - please include road names and numbers, landmarks, etc
Hwy 150 west to Bluefeild Road - Turn right or North Follow approx 2 miles to Big Indian Loop
Road which will be on the left 577 Big Indian Loop is approx 1/2 way around the loop so either
way will get you thele There is 11U ITIallbox as it Is riew constiuctlurt
Latitude (in decimal degrees)
Longitude (decimal degrees)
5 Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc ) residential - replacing existing old wood sea wall with cement block
6 Property size (acres) 79 acres
7. Lake/ river/ ocean adjacent to property
Lake Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary) Budding new home - previous cottage was built in the late 60's
currrent wood seawall appears to be similar age - want to replace with cement block wall
9 Will work be conducted from land? From water? ❑
10 Total amount of disturbance (including all excavation, backf►II, rip rap, retaining walls, etc )
below the normal pool lake level/ Normal Water Level in square feet or acres
2ftX 80ft
11 Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc ) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres.
1 ftX80ft
12 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) no trees impacted
grassy area is adjacent to current wood sea wall
,4t- A /f'�, Steven J Rotman Owner 3 -16 -15
Owner/Agent's Signature* (15A NCAC 02H .0502(f)1 Date
*Agent's signature is valid only if an authorization letter from the owner is provided
FORM SSGP 10 -2013 Page 2 of 3

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- Driving Directions from Mooresville, North Carolma to 577 Big Indian Loop, Mooresvill . Page 1 of 2
Notes
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Trip to
577 Big Indian Loop
Mooresville, NC 28117 -9045
6 41 miles / 12 minutes
Mooresville, NC
1 Start out going southwest on S Main St / NC -152 toward E McLelland Ave Map
2 Take the 1 st right onto W McLelland Ave Map
If you reach Catawba Ave you've gone about 0 2 miles too far
3 Turn left onto E Plaza Dr / NC -150 Continue to follow NC -150 Man
Ol
4 Turn right onto Bluefield Rd Map
Bluefield Rd is 0 3 miles past River Hviy
Paneta Bread is on the comet
5 Turn left onto Big Indian Loop Map
Big Indian Loop is 0 5 miles past Joshua Ln
If you reach Challenge Ln you've gone about 0 5 mules too far
6 Take the 1 st right to stay on Big Indian Loop Map
If you teach Jess Ct you've gone about 0 1 miles too far
7 Take the 1st left to stay on Big Indian Loop Map
Big Indian Loop is just past Tomahawk Ln
If you reach the end of Little Indian Ln you've gone about 0 1 miles too far
8 577 BIG INDIAN LOOP is on the right Map
Your destination is 0 3 mules past Chui chill Ln
If you reach Castle Dr you've gone about 0 1 miles too far
577 Big Indian Loop, Mooresville, NC 28117 -9045
http / /www mapquest com/ print ?a = app .core.e13617993d92c87112la84cd
Download
Free App
0 08 Mi
0 03 Mi Toral
10 Mi
10 Mi Total
24Mi
3 41"A Total
1 5 Mi
4 9 Mi Total
0.3 Mi
5 211A Total
05Mi
5 7 Mi Total
07Mi
6 4 Mi Total
3/16/2015

Driving Directions from Mooresville, North Carolina to 577 Big Indian Loop, Mooresvill... Page 2 of 2
Total Travel Estimate: 6.41 miles - about 12 minutes
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their content, road conditions or route usability. You assume all risk of use. View Terms of Use
http:// www .mapquest.com/print ?a= app.core.e 13617993d92c871121 a84cd 3/16/2015

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