20190173 Ver 2_Shoreline Stabilization_20200417

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:*
Robert J & Shelly C Strickland
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
3742 Fords Street
Address Line 2
City
Lake Norman of Catawba
Fbstal / Zip Code
28682-9735
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
Asigned and dated copyof the Agent Authorization letter:*
Agent Form.pdf 377.83KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Robert Strickland ramp Lot 55
State / Rovince / Region
North Carolina
Country
United States
If your project has a formal name please use this. If your project does not ha\,e 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 ha\e 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: vicinity map.pdf
Latitude:* 35.590030
878.42 KB
Longitude:*-80.944300
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 624.17KB
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.docx 20.08MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Terrell
County:* Catawba
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 3751 Fords Street Terrell NC 28682 Lot 55
Include phase/lot nunber
Directions to site:*

get on 1-277 South, follow 1-77 North to NC 150 w/w Plaza Drive in
Mooresville, take exit 36 for 1-77 North, continue on NC 150 West
drive to Fords Street in Lake Norman of Catawba
Rease include road naves and nunbers, landnerks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
existing ramp was resurfaced
Residential, undeveloped, etc.
6. Property Size .76
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
to launch water craft
8. How will the work be done?* IJ From Land
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 w alls, etc.)
200
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)
none
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:
o I have given true, accurate, and complete information on this form;
o 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")
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');
o 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:* Beth Mosteller
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20190173
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
r Yes f No
Version:* 2
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. 55 PLAN NO. PARCEL ID: 462701250313
STREET ADDRESS: 3751 Fords Street, Terrell, NC 28682
Please print:
Property Owner: Robert J Strickland
Property Owner: Shelly C Strickland
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):
3742 Fords Street Terrell NC 28682
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
uthorized nature Authorized Signature
Date: Date:

Parcel ID 462701250313; Property Address 3751 FORDS ST TERRELL NC 28682; Owner
STRICKLAND ROBERT J & STRICKLAND SHELLY C; Acreage:.76; Latitude 35.590030 Longitude
-80.944300; Lot 55; Boat Ramp; Mailing Address 3742 Fords Street, Terrell, NC 28682; Phone 703-
957-9339; Email she[[e-mail]

Parcel ID 462701250313; Property Address 3751 FORDS ST TERRELL NC 28682; Owner
STRICKLAND ROBERT J & STRICKLAND SHELLY C; Acreage:.76; Latitude 35.590030 Longitude
-80.944300; Lot 55; Boat Ramp; Mailing Address 3742 Fords Street, Terrell, NC 28682; Phone 703-
957-9339; Email she[[e-mail]

State of North Carolina
Department of Environment and Natural Resources
DWRDivision of Water Resources
15A NCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Agent's signature is valid only if an authorization letter from the owner is provided.
Full Pond/
Normal Water Level
mar.. �
Shoreline
Lake
(At Full Pond/Normal Water Level)
Existing boat ramp
was poured when
o lake was down 6 ft
x below 760 elv.
0
Robert J & Shelly C Strickland
3751 Fords Street
Terrell, NC 28682
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

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