20201228 Ver 1_Shoreline Stabilization_20201027

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/22/2020 10:22:17 AM (Submittal)
Submit by Montalvo, Sheri A 10/27/2020 11:04:09 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 10/22/2020 10:22 AM

Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to viewthe form.
Attach documentation of Pre -Filing Meeting Request here:
Meeting Request Form.pdf 444.51KB
Pre -fling Meeting or Request Date 9/21/2020
ID# 20201228 Version 1
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]
Rease provide an email address for payrrent and requests for pure information here.
Owner Information:
Name: * Mandi Ajjan
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
125 Milford Circle
Address Line 2
City
State / Frovince / Region
Mooresville
NC
Fbstal / Zip Code
Country
28117-7011
US

Is there an agent working on the
project? *
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:*
Email:
Phone Number:*
Mailing Address:*
F Yes
f^ No
Janice Estep
CBC Stone & Recycling, LLC
[e-mail]
[phone]
(XXX)XXX-XXXX
Address
638 Oakridge Farm Hwy
Address Line 2
City
Mooresville
Fbstal / Zip Code
28115
Asigned and dated copyof the Agent Authorization letter:*
Auth. Form.pdf 243.94KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* AjjanProperty
State / Province / Fbgion
NC
Country
United States
If your project has a formal name please use this. If your project does not hake a formal name, please identify your project by
the owner name and proposed acti\ity (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.*
r Upload File
r Lookup address
Upload Map: Survey.pdf
Vicinity Maps.pdf
Directions.pdf
Latitude:* 35.518846
343.93KB
1.52MB
225.92KB
Longitude:*-80.926250
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 329.75KB
Buffer Form.pdf 391.7KB
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.)*
Buffer Pics.pdf 2.87MB
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:* 151 S. Longfellow Ln. Mooresville, NC 28117 Lot 1212 The Point
hdude phasdot nun ber
Directions to site:*

610 E Center Ave
Mooresville, NC 28115
Take E Statesville Ave to E Center Ave
1 min (0.2 mi)
Head west toward E Statesville Ave
246 ft
Turn left toward E Statesville Ave
197 ft
Turn left onto E Statesville Ave
0.1 mi
Take NC-1100 to New Haven Dr in Davidson
21 min (10.7 mi)
Turn right onto E Center Ave
0.4 mi
Turn left onto S Church St
0.4 mi
Turn right onto E Wilson Ave
1.5 mi
Continue onto NC- 1100/Brawley School Rd
7.3 mi
At the traffic circle, take the 2nd exit onto NC- 1100
1.0 mi
Drive to S Longfellow Ln
1 min (0.3 mi)
Turn left onto New Haven Dr
0.1 mi
At the traffic circle, take the 1st exit onto S Longfellow Ln
0.2 mi
151 S Longfellow Ln
Mooresville, NC 28117
Rease include road narres and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Undeveloped lot
Fbsidential, undeveloped, etc.
6. Property Size 0.92 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Install 4 tandem dump truck loads of dirt in buffer to bring up 760 line.
Install river rock in a 4' to 12' wide area from pipe to shoreline. Install
plantings in buffer at dirt installation area and install mulch.
8. How will the work be done?* PF From Land
r 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.)
0' below
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.)
Installation area for
dirt and river rock
(approx. 3000 sf
for both) 10' x 50'
access corridor
(500 sf. temp
impact)
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees, for instance)
Grass buffer, no trees removed.
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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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");
0 1 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:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201228
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION.
LOT NO. I � PLAN NO. P l 2 PARCEL ID: 4 6 2-4 69 634 5. o o u
STREET ADDRESS: 151 J . Low
00 r e-S V"�
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Please print: M
Property Owner:
Property Owner: H q- n
IX2SH
The undersigned, registered property owners of the above noted property, do hereby authorize
of � X "4 seek) Sc--�- �cs 5,�-ryt'ce-s LLG
rtractor / Agent} k (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 pro erty above):
17-S M140rd c-;,-, moo
Telephone: -�O 4- 5'� 5- 5 03 2 j
We hereby certify the above information submitted in this application is true and accurate to the
best of our knGwiedge.
Mt)�j�
Authorized SiTnature Authorized Signature
Lute: 9 15 d 2-0 Zo bate:

DON ALLEN & ASSOCIATES, P. A.
Since 1971"
Commercial •Residential ' Mortgage Surveys ' Multi —Family
Construction Staking • Subdivision Design ■ Topographical
131 Crosslake Par& Drive -- Suite 102 • Mooresville ' NC • 28117
(704) 664--7029 [phone] Fox
1, certify that this map was drawn under my supervision from an actual
survey made under my supervision recorded in deed book221spage 1t35__, and/or
plat t3oak_ 43 __, p0ge__106_— that the ratio of precision is 1':10,000, that this reap
was prepared in accordance with the General Statutes of North Carolina Chapter 89C.
my hand end sea': on the _ ? day of _ T- _
A.D. 20 18 OC� .._ .. ... _�_
fr
+MLLIAM M. ALLEN, P��� GARCJ4��,r.
tF�O 2'.i
`�
LAKE
NORMAN
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�� tiER PGtiAL FtETfl St1 n
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� �YBPG'R Fad µUl1
BIF' CR rRaMc
�60 CONTevR
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1 :o LOT 1211
N� Nausr aax G z CARRATELLO DOMENICK
j m 1808\1359
LOT 1213 NEIC#�aHS oRrvE
ARLEDCE FAMILY 2012 '05' SETOACK NUG OARS WA3
CIFTINC TRUST % u rr�ca+eaRs ww
221511135
LOT 1212
0.92 AC. N�
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LEGEND
P P. = POWI_R POLE CAa�E —O
p = POWER TRANS. sax �xCl o-comc
E.I.P. EXISTING IRON FOUND
MON
LP.S. _ x4 REBAR SET
R/l4 = RIGHT—OF—WAY
VlnNITY MAP NO SCALE
�° SOUTH
NOTES LONGFELLOW LN.
1) THIS PROPERTY MAY BE SUBJECT ax N (40' PUBLIC R\W)
TO ANY EASEMENTS AND/Oft
RIGHTS OF WAY OF RECORD.
2) ACREAGE COMPUTED BY 7HF
COORDINATE METHOD.
3) UNDERGROUND POWER
4) NO GRID MONUMENT FOUND WITHIN
2000 FEET.
O' 25' 50' 100' BOU N OAR Y SURVEY
OF
SCALE IN FEET 151 S. LONGFELLOIN LN.
LOT 1212 THE 201NT PHASE 12
SCALE 1•• — 50' DAVIaS6N TWSR.. IREaELL CO., N.C. PTO SOCKC 502—A
�: PO4KT 1V2 PH12
ACQUIRED BY: MAHDI & HAYA AJJAN DC nm.
TAX MAP Ka: 462a6g9,745
CURVE TABLE
CURVE
RADIUS
LENGTH
BEARING
CHORD
Cl
SO.OG'
32 &4'
S 69'S2'00" E
32.25'
LINE TABLE
LINE
BEARING
LENGTH
L1
N 64'02'32' W
50 D9`
L2
N 48'25'48" W
64 97'
L3
N 77'T6'17' M1
65-97'
L4
N 85'29'28' sy
48.49'
L5
N 89'49'O4" W
36_p4'
LS
S 82'35'33" W
46.$3'

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Lake
(At Full Pond/Normal Water Level)
1 3r15 }ctj R NI V e ?. ROCK
Full Pond/ :ns1rait P1on+tnaS ` i Locd-e- Frorn
I+.A �FI<eY +0 ShoredrIl.c-
Normal Water Level..r....■�7
Shoreline
fca brin c3 v `tU0 tine.
10'
+sa I o%
ACCESS
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 10 ft 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

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: � 51 � , L'°")
nic- 291lt-4 U�
Owner:R aV, � A
Print (JU
Contractor/agent: VIiLv 6't"vt gczJP-
Print
edDci L-avi"H6ore-SV,AGunty. T-f JeX.i
r ,off f Signatultl"^fIA l j
L Lc-- I 1 � K. , A. )p/l�Tn it
The approval is for the purpose and design described in your application. 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 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed frorn 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. 115A NCAC 02B .0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .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 02B .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 02B .0243 (4), (6), (8)]
Stormwater 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. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
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: q i q� 2®�

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