20200454 Ver 1_Shoreline Stabilization_20200406

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/2/2020 11:21:33 AM (Submittal)
Approve by Strickland, Bev 4/6/2020 9:59:34 AM (Non -DOT - Approver)
• Montalvo, Sheri A reassigned the task to Strickland, Bev 4/6/2020 7:33 AM
* Could not send this one through. I am assuming because M made the change of asking for the
name of the water body. Can you send it through for me? It's alan Johnson and the DWR@ is
20200454.
Thanks
Sheri
• The task was assigned to Montalvo, Sheri A 4/2/2020 11:21 AM

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: *
Email:*
Phone Number:*
Mailing Address:*
Is there an agent working on the
project?*
Agent/Consultant Information
Name:*
Company Affiliation:*
Email:
Phone Number:*
John and Christine Miller
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
171 Binns Road
Address Line 2
City
Mooresville
Fbstal / Zip Code
28117-7002
r Yes
r No
Phillip Rotella
Lake Vision Development, Inc.
State / Rovince / Fbgion
NC
Country
us
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:*
Street Address
2242 Longcove Court
Address Line 2
city
Sherrills Ford
Postal / Zip Code
28673
Asigned and dated copy of the Agent Authorization letter:*
sea wall stabilization permit_C&J
Signed.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 021-11.0502(a) & (b)]
..................................................................................................................................................................................................................
Project Name:* Rip Rap to complete Shoreline Stabilization
State / Province / Region
NC
Country
US
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 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
Upload Map: Screen Shot 2020-03-31 at 1.45.10
3.34MB
PM.png
Latitude:* 35.511030 Longitude:*-80.950644
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*
171 Binns Site plan.pdf 85.7KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%2OLayout.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.)*
Screen Shot 2020-03-31 at 3.42.09
1.9MB
PM.png
4. Location of the property (where work is to be conducted)
Nearest Town:* Mooresville
County:* Iredell
Lake/ river/ ocean adjacent to
property:

Subdivisions name or site address:* 171 Binns Road
Include phase/lot nun ber
Directions to site:*
BSR r on Tussore Trail r on Binns Road, lot on 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:*
residential
Residential, undeveloped, etc.
6. Property Size .799
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
install rip -rap to complete shoreline, access through buffer
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, back fill, excavation, rip rap, retaining walls, etc.)
816
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.)
204
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nurrber of trees, for instance)
removal of brush or tree along impact area IF necessary
Sketch: 171 Binns Site plan.pdf 85.7KB
sketch 171 Binns Road 4.pdf 79.18KB
sketch 171 Binns Road.pdf 77.88KB
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):
$240.00 for impacts to lake (below normal water level) of less than 1 acre
$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:* Phillip Rotella

Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200454
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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION,
LOT NO. PLAN NO. LO PARCEL ID:
STREET ADDRESS: f I -Ot t� w c, 2p
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Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
'P4 1 LL-! P -RLrT-e LL-a of �Zvie V C.
(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):
Telephone: -N&4- Ce (-2-, gt'o
Z��-V? All� C-1 C7- Ttj�j I -nurl
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authonzed Signature Authorized Signature
Date: Date:�13 t � 2-0

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