20200646 Ver 1_Shoreline Stabilization_20200518

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/15/2020 8:57:58 AM (Submittal)
Approve by Montalvo, Sheri A 5/18/2020 10:41:48 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 5/15/2020 8:58 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:*
Rodney Shaffer
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
2920 Greenbrook Way Northeast
Address Line 2
City
Atlanta
Fbstal / Zip Code
30345-3754
r Yes
r No
Terri Kindley/ Shannon Miller
Lake Norman dock and dredge
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Rovince / Fbgion
GA
Country
us

Mailing Address:* Street Address
PO Box 3156
Address Line 2
city
State / Rovince / Region
Mooresville
NC
Fbstal / Zip Code
Country
28117
US
Asigned and dated copy of the Agent Authorization letter:*
2020-05-15 08.42.34.pdf 257.61 KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
................................................................................................................................................................................................
Project Name:* Rodney Shaffer Shoreline Stabilization
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: OD395E7D-69F8-44AO-97CB-
E2B0768EA24F.jpeg
Latitude:* 35.552949
251.09KB
Longitude:*-80.958020
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*
80 E F B D EC- D CA5-4269-988A-
3.58MB
D83C96679153.jpeg
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.)*
348750F1-DDC4-4291-AF2A-
3.14MB
96E94BOA7915.jpeg
1 AC906D9-OE8F-4A49-9183-
4.62MB
E5DFF6DA3738.jpeg
4. Location of the property (where work is to be conducted)
Nearest Town:*
Sherrill's Ford/Terrell
County:* Catawba

Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address:* 8757 Bass Drive Terrell NC 28682
Include phasellot nunber
Directions to site:*
177 exit 36 NC/150 toward Lincolnton 6.5 miles
Left onto Kiser Island Road 3.1 miles
Right onto Bass Drive 200 feet
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 0.48 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Refurbish to existing Rip Rap for shoreline stabilization.
All work to be done by water using barge and long reach.
8. How will the work be done?* r From Land
17 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.)
300
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.)
0
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)
0
Sketch: F23A325E-E4E6-4A4E-8412-
883.34KB
970D7EF21 DD8.jpeg
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:* Terri Kindley
Signature:
CAI-
-� -k.

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200646
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:
Igir_►izm?I��
STREET ADDRESS:
Y C�
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Please print:
Property
Owner:�}�
Property
Owner:
PARCEL
ID:
The undersigned, registered property owners of the above noted property, do hereby
authorize
K a • of Lis,
(Contract Agent) M 1 ��� (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 Owners Address (if different than property above):
AlAa* 64 gt),qq6 "'
Telephone: VD _04_ 0 -
We hereby certify the above information submitted in thls application is true and
accurate to the best of our knowledge.

Terrell
vO
G`1pvess St
rend
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8757 Bass Dr

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