20200449 Ver 1_Shoreline Stabilization_20200403

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.
Owner Information:
Name:*
Stacey Goslin
Email:*
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
6833 Simmons Way
Address Line 2
City
Moorpark
Fbstal / Zip Code
93021
Is there an agent working on the r Yes
project?* r No
Agent/Consultant Information
Name:* Janice Estep
Company Affiliation:* CBC Stone & Recycling, LLC
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
State / Rovince / Fbgion
CA
Country
United States

Mailing Address:*
Street Address
638 Oakridge Farm Hwy.
Address Line 2
city
Mooresville
Postal / Zip Code
28115
Asigned and dated copy of the Agent Authorization letter:*
Stacey Goslin.pdf 248.21 KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Stacey Goslin
State / Province / Region
North Carolina
Country
United States
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. *
f Upload File
r Lookup address
Property Address Lookup:* Street Address
8486 Monbo Road
Address Line 2
City
Catawba
Fbstal / Zip Code
28609
Latitude:* 35.667359
State / Province / Region
NC
Country
US
Longitude:*-80.969999
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 314.99KB
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 and Access.pdf 2.83MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Catawba
County:* Catawba

Subdivisions name or site address:* 8486 Monbo Rd. Catawba, NC 28609 Lot #4
Include phase/lot number
Directions to site:*
Head south on Evergreen St toward E Center Ave
20 s (197 ft)
Take NC-1 50 Wand Sherrills Ford Rd to Monbo Rd in Catawba
30 min (16.4 mi)
Turn right onto Monbo Rd
Destination will be on the left
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
Residential, undeveloped, etc.
6. Property Size .58 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Shape and slope shoreline, install matting and boulder rip rap for
new shoreline stabilization
8. How will the work be done?* V From Land
r From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
520 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.)
130 sf shoreline,
10' x 50'
construction
access (500 sf
temporary impact)
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)
Undeveloped lot, remove brush and small undermined trees on
immediate shoreline, minimal disturbance to buffer
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:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the

"Uniform Electronic Transactions Act")
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');
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
I intend to electronically sign and submit this form.
Full Name:* Stacey Goslin
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200449
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
r Yes f No
Version:* 1
Alan Johnson:eads\adjohnson1
Mooresville Regional Office - [phone]
r No Payment Needed
f Fee Received
r Need Fee - send electronic notification
* $240.00
f $570.00

AGENT AU HORIZAnON FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 'PLO NO. PARCEL ID:
STREET ADDRESS; �S LI al a .�_—
�T�'
Please print: -"-(�� 1 .
Property Owner: L1j �J
Property Owner,
The undersigned, registered properly owners of the above noted property, do hereby authorize
of �. c U Y 1 C� eC C- l i Yl C{
(Contractor l Agent) (Name of consulting firm)
to act on any 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):
I OA. q 300-q
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Date: 3-, a Q —). O

Full Pond/
(Normal Water Level
Shoreline
Lake
(At Full Pond/Normal Water Level)
('301
x q V--� b,e-loQ--)
30 ` X I (�+ above.
I e.nai--h
U rd&.\JelopQi
{ ©' Io+
( �c`s5
1-�o
-DoLY)
0 � � � � �
IAemove, brush
and srrnalk u nde.rm►ned
Sho-re I'►rX'Q'
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10ftx 100ft)*:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
I 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