20200483 Ver 1_Shoreline Stabilization_20200409

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/6/2020 2:35:26 PM (Submittal)
Approve by Montalvo, Sheri A 4/9/2020 4:21:50 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 4/6/2020 2:35 PM

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:*
Travis D & Mindy H Lavang
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
80 Putters View Lane
Address Line 2
City
Maiden
Fbstal / Zip Code
28650
r Yes
r No
Beth Mosteller
State / Rovince / Fbgion
NC
Country
US
Dale & Beth's Lake Use Permit Service
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:*
Street Address
988 Clear Creek Circle
Address Line 2
city
Lincolnton
Fbstal / Zip Code
28092-8005
Asigned and dated copy of the Agent Authorization letter:*
Agent.pdf 416.66KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Travis Lawing
State / Rovince / Region
NC
Country
US
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
7455 Ivey Drive
Address Line 2
City
Sherrills Ford
Fbstal / Zip Code
28673-9377
Latitude:* 35.591460
State / Frovince / Pegion
NC
Country
US
Longitude:*-81.002970
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*
page 3.pdf 773.09KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/O/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.)*
pictures.pdf 1.19MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Sherrill Ford
County:* Catawba

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* Reid A Beatty
Include phase/lot nunber
Directions to site:*
from 526 S.Trade St. Charlotte NC, head NE on S Trade toward
Main St, Road name changes to N Trade St, Road name changes
to Sam Newell Road, turn left onto US-74 W/E Independence blvd,
at exist 242 take ramp right for 1-277 N / NC 15 North toward outer,
at exit 5A take ramp right for 1-77 N / US 21 N toward Statesville,
exit 36 take ramp right for NC-1 50 toward Lincolnton/Mooresville,
turn left onto NC-1 50 / W Plaza Dr, turn right onto Sherrills Ford
Rd, Turn left onto Beatty Rd, Bear left onto Pleasant Ln, Bear left
onto Ivey Dr, Arrive at Ivey Dr on right
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
Fbsidential, undeveloped, etc.
6. Property Size .560
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
repair of existing boat ramp
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.)
236.25
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 w alls, etc.)
78.75
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)
none
Sketch: plat.pdf 1.63MB
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:* Beth Mosteller
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200483
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 AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 2 PLAN NO. PARCEL ID: 460701465149
STREET ADDRESS: 7455 Ivey Drive, Sherrills Ford NC 28673
Please print:_
Property Owner: Travis D Lawing
Property Owner: Mindy H Lawing /��
The undersigned, registered property owners of the above noted property, do hereby authorize
_Beth Mosteller of Dale & Beth's Lake Use Permit Service
(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):
80 Putters View Lane, Maiden, NC 28650-9692
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: Date: q- .3 r 26 A 6

Owner/Agent's Signature* Printed Name Date
[15A NCAC 02H .0502(f)l
'Agent's signature is valid only if an authorization letter from the owner is provided.
Lake
(At Full Pond/ Normal Water Level)
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C kto� 1,�
11...., A �,. j / 14,
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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

Travis D & Mindy H Lawing; 7455 Ivey Drive, Sherrills Ford, NC 17673; Lot 2; Acreage .560; PIN
460701465149; Latitude 35.591420; Longitude-81.002980; Home address 80 Putters View Lane,

Travis D & Mindy H Lawing; 7455 Ivey Drive, Sherrills Ford, NC 17673; Lot 2; Acreage .560; PIN
460701465149; Latitude 35.591420; Longitude-81.002980; Home address 80 Putters View Lane,
Maiden, NC 28650-9692; Phone [phone]; Email [e-mail]
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Travis D & Mindy H Lawing; 7455 Ivey Drive, Sherrills Ford, NC 17673; Lot 2; Acreage .560; PIN
460701465149; Latitude 35.591420; Longitude-81.002980; Home address 80 Putters View Lane,