20200721 Ver 1_Shoreline Stabilization_20200601

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/1/2020 10:06:57 AM (Submittal)
Approve by Montalvo, Sheri A 6/1/2020 1:02:06 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 6/1/2020 10:06 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:*
Tim Clayton
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
20726 Rio Oro Drive
Address Line 2
city
Cornelius
Fbstal / Zip Code
28031-6708
r Yes
r No
Saundra B Mosteller
State / Rovince / Fbgion
NC
Country
US
Dale & Beth Lake Use Permit Service
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:*
Street Address
988 Clear Creek Circle
Address Line 2
city
Lincolnton
Postal / Zip Code
28092
Asigned and dated copy of the Agent Authorization letter:*
Authorization. pdf 359.67KB
Catawba Rip.pdf 646.81 KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 021-11.0502(a) & (b)]
Project Name:* Tim Clayton
State / Province / Region
North Carolina
Country
United States
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.*
- Upload File
r Lookup address
Property Address Lookup:* Street Address
20726 Rio Oro Drive
Address Line 2
City State / Province / Region
Cornelius NC
Fbstal / Zip Code Country
28031-6708 US
Latitude:* 35.497394 Longitude:*-80.890893
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*
Abbreviated PCN shoreline New (1) page
139.23KB
3.docx
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.)*
pictures.docx 1.48MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Cornelius

County:* Mecklenburg
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* Bahia Bay Section 1
Include phase/lot number
Directions to site:*
get onto 1-277S, follow 1-177N to US-21 S/Catawba Ave in
Cornelius, take exit 28 fro 1-77N, Take Torrence Chapel Rd to Rio
Oro Dr.
Rease include road narres and nurrbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
residential
Residential, undeveloped, etc.
6. Pro pertySize 0.248
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
due to wave action
8. How will the work be done?* Gl 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 w alls, etc.)
153.16
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.)
153.16
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(number of trees, for instance)
grass -fescue, no trees removed
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:
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")
• 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:* Beth Mosteller
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200721
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. 17 PLAN NO. PARCEL ID: 20726
STREET ADDRESS: 20726 Rio Drive, Cornelius, NC 28031
Please print:
Property Owner: Tim Clayton
Property Owner:
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):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
rized Signature Authorized Signature
Date: Y -� o� 19 Date:

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 20726 Rio Oro Drive, Cornelius, NC 28031
Owner: Ti
Print
Contractor/agent: Beth M
Print Signature
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A NCAC
02H .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be removed.
Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243 (6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. There are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
I, Tim Clayton hereby state that I have been informed of the Catawba Riparian Buffer Rule. Any
work conducted in the buffer, not specifically stated in the application and approved by the Division of Water
Resources (DWR), is a violation and subject to enforcement. Due diligence will be taken such that the
construction will be built within substantial compliance and intent of the 401 Water Quality Certification and
Buffer Rules, the approved_plan(s) a9d,4cifio tion(s), and other supporting materials.
Signature (owner): 4-- 4 Date:

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
La ke
(At Full Pond/Normal Water Level)
0000000000000000000000000000000000000000
1111111111111111111111111111111111111111
�� � 1111111111111111111111111111111111111111
i 1111111111111111111111111111111111111111
_ 1111111111111111111111111111111111111111
153.16' to follow contour of shoreline,
one foot above full pond,
and 3-4 feet below full pond
Tim Clayton
20726 Rio Oro Drive
Cornelius, INC 28031
Please approximately sketch the following information on this plan (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

Tim Clayton; 20726 Rio Oro Drive, Cornelius, NC 28031; Phone [phone]; Email
[e-mail]; PIN 00129770; Lot 17; Acreage 0.248; Latitude 35.497390; Longitude -
80.890860; Shoreline Stabilization rip -rap -re -do; 153.16 ft of shoreline
—or"-7
E
st

Tim Clayton; 20726 Rio Oro Drive, Cornelius, NC 28031; Phone [phone]; Email
[e-mail]; PIN 00129770; Lot 17; Acreage 0.248; Latitude 35.497390; Longitude -
80.890860; Shoreline Stabilization rip -rap -re -do; 153.16 ft of shoreline