20200733 Ver 1_Shoreline Stabilization_20200608

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/5/2020 1:16:33 PM (Submittal)
Approve by Montalvo, Sheri A 6/8/2020 11:55:53 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 6/5/2020 1:16 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:' Mike Greene
Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* S
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Is there an agent working on the
project? *
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:*
Email:*
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Janice Estep
CBC Stone & Recycling, LLC
[e-mail]
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Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
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Asigned and dated copy of the Agent Authorization letter:*
Auth Form.pdf 212.46KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 021-1.0502(a) & (b)]
Project Name:* Greene Property
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 acti\ity (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.*
f- Upload File
r Lookup address
Upload Map: Plat.pdf 565.94KB
Vicinity.pdf 1.79MB
buffer form. pdf 346.28KB
duections.pdf 242.3KB
Latitude:* 35.464074 Longitude:*-80.910707
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*
Site Plan.pdf 314.2KB

Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/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.)*
Shoreline Pic.pdf 4.72MB
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:* The Peninsula Lot #126
Include phase/lot nunber
Directions to site:*

610 E Center Ave
Mooresville, NC 28115
Take S Main St, NC-115 S, Langtree Rd, I-77 S/US-21 S, ... and Jetton
Rd to Peninsula Club Dr in Cornelius
20 min (11.2 mi)
Head west on E Center Ave toward Cedar St
0.5 mi
Turn left onto S Church St
0.5 mi
Turn right onto College St
0.1 mi
Turn left onto S Main St
1.2 mi
Continue onto NC-115 S
2.1 mi
Turn right onto Langtree Rd
1.1 mi
Use the left 2 lanes to turn left onto the Interstate 77 S/US 21 S ramp
0.2 mi
Merge onto I-77 S/US-21 S
2.9 mi
Take exit 28 for US-21
0.2 mi
Merge onto W Catawba Ave
1.0 mi
Turn right onto Jetton Rd
1.4 mi
Continue on Peninsula Club Dr. Drive to Balmore Pines Ln
2 min (0.6 mi)
Turn left onto Peninsula Club Dr
0.4 mi
Turn left onto Mulligan Ln
495 ft
Turn right onto Balmore Pines Ln
Destination will be on the left
161 ft
18524 Balmore Pines Ln
Cornelius, NC 28031
Rease include road nacres and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Residential, undeveloped, etc.

6. Property Size 0.579 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Reshape and re -slope existing shoreline. Install matting and boulder rip
rap for maintenance on existing shoreline
8. How will the work be done? * I7 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.)
4' below (372 sf)
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
V above (93 sf) 10'
x 50' access
corridor (500 sf
temp. impact)
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 buffer, no trees removed, minimal disturbance to buffer
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $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:* Janice Estep
Signature:
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Initial Review
Is this accepted into the review
process?*
Project Number:* 20200733
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. U _ PLAN NO. PARCEL ID:
STREET ADDRESS: 1 �-
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Please print:
Property Owner: __ J, M cs�--(_
Property Owner: G
The undersigned, registered property owners of the above noted property, do hereby authorize
_Uim- of CBC n �.nrj . LLC_
(Contractor / Agent) (Name of consulting fi )
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: '101-- U+4 !_l
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
ut zed Signature Authorized Signature
Date: Date: 5� 2

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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Narne/address: I V-C Rn F )' aunty:
Owner:
Print J Si ure
Contractor/agent:
Print JAiihature
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(g)]
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), (s)]
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
1, 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) and specification(s), and other supporting
materials. -4
Wignature (owner):
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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 fi)*:
I. 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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