20200475 Ver 1_Shoreline Stabilization_20200407

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 B Hood
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
4323 Quail View RD
Address Line 2
City
Charlotte
Fbstal / Zip Code
28226
r Yes
r No
Mike Sticco
State / Rovince / Fbgion
North Carolina
Country
United States
Boulder Creek Landscape and Design Inc.
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:* Street Address
P. O. Box 457
Address Line 2
city
State / Province / Region
Sherrills Ford
North Carolina
Postal / Zip Code
Country
28673
United States
Asigned and dated copy of the Agent Authorization letter:*
Hood1.pdf 1.54MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Hood Seawall
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
151 Old Arborway Road
Address Line 2
City State / Province / Region
Mooresville NC
Fbstal / Zip Code Country
28117-6805 US
Latitude:* 35.544578 Longitude:*-80.947513
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*
Hood1.pdf 1.54MB
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.)*
IMG_0155.jpg 3.87MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Mooresville
County:* Iredell

Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address:* Lot 137
Include phase/lot nunber
Directions to site:*
Brawiey Schoold Rd south; right on Chuckwood, left on Barber
Loop, left on Arborway, left on Old Arborway RD, 151 Old
Arborway on left
Rease include road naves and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential lake lot
Fbsidential, undeveloped, etc.
6. Property Size .66
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Install retaining wall; remove old rotting wood boards reuse
existing rip rap
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.)
200
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.)
600
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
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):
$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

o I intend to electronically sign and submit this form.
Full Name:* John B Hood
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200475
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

State of North Carolina
Department of Environment and Natural Resources
ow
Division of Water Resources
atvtslonof r 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: 5SGP 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 & Suffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
1. Applicant Information 15A NCAC 02H .0502 a
1. Owner Information
Name:
Mailing Address:
Telephone Number: '70q-6W-OU Fax Number:
E-mail Address: nacA e e roliao-ca-k cuoriL
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.rnii/pgrtals/59/doglregulatony regdocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form_
Name: . onke 6•kccp _....,__..,__.
Company Affiliation: 'er Greek LonA61W Q 61.eN L• _
Mailing Address: ,D,0- 8ol 46'7 _
c
Aerri_l"_r (067.3
Telephone Number: WI - 9l_7 1-i fO Fax Number:
E-mail Address: M I E? adflon Rcali Lida)
Person to receive the Certification Approval: f'li k- 41cc o
H. Project Information [15A NCAC 02H .0502(a) & (b)1
1. Attach a vicinity reap (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 3

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
of some sort- a yard stick, shovel handle, etc.)
4, Location of the property (where work is to be conducted)
County: ;2�seUe Nearest Town: MobreSUIL _.
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
U _'_hU4 A-Urq fvok+ a n d utkW00 .. le_-Q— on) &r edw
MOM
Latitude On decimal degrees) 312, 1 0Z0 Longitude (decimal degrees) �.7 7 4
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): sa�611-0410, T
6. Property size (acres): 6 0-tne
7. Lake/ river/ ocean adjacent to property: till orts�1
B. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): tft6l! I- u.l ill%) w t l � .. -- tcL w COA6orL
9. Will work be conducted from land? E^ From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, Etc.)
below the normal pool lakIplevel/ Normal Water Level in square feet or acres:
11.. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake Vvel/ Norrrgal Water Level and 50 feet land -ward in
square feet or acres:
12. Please describe the vegetation above
normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance):
r k a,SJ
er/Agent's Signature
Printed Name
I_15A NCAC 02H .0502(f)1
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: ssGP 10-2013
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Date
Page 2 of 3

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Please approximately sketch the following information on this plan (provide dimensions for each
item, such as loft x I00 ft)*:
3. 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 wails, docks, etc.
S. 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

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