20200777 Ver 1_Shoreline Stabilization_20200612

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/11/2020 5:55:02 PM (Submittal)
Approve by Montalvo, Sheri A 6/12/2020 11:45:27 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 6/11/2020 5:55 PM

Shoreline Stabilization Application Form
15ANCAC 02H .0500 —Water Quality Certification, Shoreline Stabilization
FORM SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TINE
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:*
Duce Henderson
[e-mail]
[phone]
()=)xxx-xxxx
Street Address
167 East Tattersall Drive
Address Line 2
City
Statesville
Fbstal / Zip Cbde
28677
a Yes
0 No
Terri Kindley/Shannon Miller
Lake Norman dredging
[e-mail]
[phone]
(xxx)xxx-xxxx
State / FTovince / f;bgion
NC
Country
US

Mailing Address:* Street Address
PO Box 3156
Address Line 2
city
State / Province / Region
Mooresville
NC
Fbstal / Zip Code
Country
28117
Us
Asigned and dated copyof the Agent Authorization letter:*
2020-06-11 16.59.33.pdf 245.75 KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
..........................................................................................................................................................................
Project Name:* Bruce Henderson/shorchne stabilization to existing Rip Rap
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.*
r Upload File
r Lookup address
Upload Map: 4CAB6E55-55ED-44ED-AA47-
224.95KB
F 1604461 FB48. jpeg
Latitude:* 35.665360 Longitude:*-80.958880
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*
3330F4BO-CC74-46D5-AE84-
3.11MB
787915F41FC5.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.)*
C4053829-FD6B-47F3-8419-
4.83MB
B92DE7367DAD. jpeg
Al5206E9-E304-4A7E-B982-
3.41 MB
A75A9EEBOE60. jpeg
4. Location of the property (where work is to be conducted)
Nearest Town:* Troutman
County: * Iredell

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 167 East Tattersall Dr.
Include phase/lot nunber
Directions to site:*
177 exit 36 Highway 150 towards Lincolnton
Right onto Perth Road
Left on State Park Road 1.1 miles. Right on HicksCreek 2 miles
Left on Monbo Road 2.1 miles. Left on E. Monbo .6 miles
Left on Heronwood A straight on Windermere .2
Left on E. Tattersall Dr. 0.3
Rease include road narres and nurrbers, landrrarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Fbsidential, undeveloped, etc.
6. Pro pertySize 0.47
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Shoreline stabilization to existing Rip Rap in eroded areas using Rip Rap.
All work to be done by water using barge and long reach.
8. How will the work be done?* r From Land
I7 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.)
450sq ft
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.)
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: 294EF0E6-F914-4F95-AE0C-
3.04MB
A255AFA3E3D5.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:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200777
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
F Yes r No
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
F Need Fee - send electronic notification
F $240.00
r $570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
ROT NO:� q3")
P1AN NO: PARCEL QA l� c� ID:
STREET ADDRESS:
Please print:
Property
Owner: [,///��}��C'
Property
Owner:
The undersigned, registered property owners of the above noted property, do hereby
authorize
�--t� " �
Y-A "-),of [Q ,�— _.Co tractor/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 Owners Address (if different than property above):
Telephone:— ! O!?— 9 9&"Q Qy� oc-G�
We hereby certify the above information submitted In this application is true and
accurate to the best of our knowledge.
�t.`�.lflfl '.{ �ivl dh

Pair
5�el
East Monbo
to Green
19
A.
�h0
L' C�
i�jtO,Qq �o�aO
® Bethel Baptist (
St Johns Church
sevo
hI>
S
t167 E Tattersall Dr

uii Pond/ I
Plan
Normal Water Level elevation
Lake
(1ov f Jf tadJ Namd wore ISNe1)
Existing Dock
3oh.�rt
r
(At Full Pond/

Me,IF
< ti F T Is 1 /
' , y cs ,
I IF
�w f t7
g4 ^i �: I�IF
'%a.., Y. tier,
"� �.'iI .rp',-?'' �1a< to i .' g �•Ir��+s ,4t ^r. pop 64 at is go'� �.f`�,►ty�''/,- a`k IF go.
, �goon " ;Sew
- per*`' d 3. ` Sa C A. `�W'�f i ]1f Lotr IIA
e ,• I A � i ' � A. /. -y.e� . .
IF
a k 1 !j . ., r. / r
t go Ojt:•k1+-
on
-
%�'. IF I
As I
e, fr i . 'i "i� -arm Viggo, ,r t '1 • 10 al
IF
of- .,, ` ._.. pp... y 7., IF
r�sy�•� y III N"t<`'i!_q,N i Iln. ,�` • -'� jtir / 5..• 1 'Fools
�'j f
..A G.MA
�. f IN I4r it., .,! v$m, t,''ry3 _C, H •`d'.`, } ' f�' _ _ lA ` •'•u/ fA ^(` r,'i%7
son'i' aYJoamot IF
I Ansp b`°k r'< `%1s k'^' tc �`..$ ��-r r S t`..
of on �i prr d' as . 4 r ;`yR r::.& ;kv� rt . r'i p- �{ .� -. �j. An It --r: r., �,on
{{�
1. - �i t !:; �v in I
R _,7. �2,,,V IF. } r ,:° IF III JIL +:lip. J.r7y i; �.,' e k� ' " yl r S'' 4 ` - i
IFFIF to$}'rT IF
Y ! =. .�...,..` `�.° t,. X P. 'b o �:. .i'F .1� 4: �. i..F r .(r AFFr aY,
-Mom"Il�il - e Z. •W1 i4a :.%'• ..t.' �`e .l
•' �• - `'. K — .� 's.� v .a". x, t An .' �.,. "' r ht_ •t �t f �'v - s . l� /.• 4 .
op '111- . raIF d�FillP' t b ', W "" �.. to -
>q n �'` x `v in.'!f�'ea a owls) An
rIF Ion T, s _f.. -.., fi(}< �,rgo not I oil Logos { *< 'i F. }"�
Non
IF
y.• LIF
�got AV I
r \ 'Y �^.� .. rI, r g %#°. 9 'AD I, CA ILLPA sN. 71 .ly, tjvY. 9 . r i,- f^ 7 .'�1
2.— :-yam t�IIA�'�•� LZ''�:� +{riry F:;,. t k>,'Z,C "�' --"S nt is on .a,. ?�• '.�C-Md
it
'�f' VoF y:>
,.=Aim; Fig, r it
,,,,
\i°•Ji:•'. r h-@ 1`_ 5 r<_ } _.7 .lsl."�' / 3�,r f•.. f aC . `r� '
a
IF
If If 0
g, — Jim, T , _ 9 a *:. , 'g S,Exr yet .. < 7" V a r
lot
of
Fir 0
on
roo
r
_. 9
- r
�on
For I An For AFILL —e;,�n
o aye�y .:="S. n"1 tool,. .,m I _.. d 7f.'t {, Y it
is f• :r'::�. ` G . L W{,� _ _r 1. ,'� �l
for
— •p,ig.. !1 .3., -.., _.� �- Y�^? i�f_':Jp��• Lj f54.. ±i i -x ./:
.•sa �+' + :°:A,. o.,-a.. _ _ la+n , - '� : /- .,is„ r,.,,.3,.w'� st; yr. III r r ,¢ �- _'.; .. y _
fago
r s
,,e+ . �'/. s . S.r ,<..:' f!r r.. _ _ '',- _ .' •u: .. yl �.. _ _ �yF,^'fy�. a.
,�<- a �. >,. , e ,r -:.. or : , : t -s : r �r v ._� i1i 4 o,n . 3f � `. 1 .yF`" { e�< !.rp F 5 u
,r` x;.< `,:c• .:,`a. c. t :^ ^+_ nnlr�o �in5 ..r't .�. .3 `'S';- i Int
..'..r , ; . , Y;. ,.., +a=. _c-.., /, >' �I ,.
4
r. -' ::. .,.p.M., xz lill'_I�II� �i• _r' /�-• ,TIC w pppp IIIIIIIIIII
e ., .• ,_ .,!><,,. .4.:-;f ,,,. F.III ullullliLl.- _}•. Av, �y Y^.
, .,.,:.r Y .,yn+ :...r - S,• --.Y�•-- .•. 1. r.I, i' lootw /,e
K 7- ....<.. ,- ^`,< - .,p..,". .. fi 1 ...xn., rf 5.>..ci ,, .r,R' .-+c:, r. 7AAAYn..II:737A, p1, 4 - Y 5
e ,� s
IfFir
LIC,
IF.
In oft I
17 fools
no
IV
­FawFloL Is
ILL
ll IF 0
0 In
- ...x ., T a; .. yrff... ,bn `� Y, '.'S"": ,a 5iL ,A}.(�' ,eP, t,. I _.4, . �' r - • Sf ` : :i a d a ' 6 •;e
'`�'r .- :•�^ - ;,.Ar.J-,�V�._`:. ;, 5;,; R�°A.M1.a# Y';, .':`3. _mm
h, t J .a-.' f`- .M
Is goo no,
is .,... �Onto
- , t,•esa.0 ,y.� ns>;' t-., yY',^p. •`-, �� n�r .�P�.. _1 '�iof
IF I
` f ii •% g r r,.t`. a y , o iY xp 7
�Fy . r . fe
�r z .. b 4 .aF_ r. i &C i n. • x t,IF
to IF IF I
IF a. olA w I to FLIFLA CIA' IF Al
PAL IF Antos I Falls A, go I, IF no"I
y
,,y� ` -.
an .;k., v +i J F.on
M.<
,
IF ALL IF
As
r i' .f..4 I - . fix - oft /." t / 4 is IF I
, 1. ,_ a ,/ yA ,'
.''
go
IF In
not w a �.,,.... r oIV
� ,`e r LIVY
vy� ,.ILL
G
III,
Lono
ILL Io
' K am, \ < .. Ali �- - — 4: E }� IF
it . ^ - - r { _ \',�" v
o • �off for - ter, _ _ / .' :�:%, ;111' ' ♦ � . '
7 of
7r. - _ As A
K .�
3
t.{ '_ . rip �,►Oft Y R - r ie. ';� a?:jy
re ..FILL
Liz�{
og
'��" F IF
"go ` l -. "r'� _ P `�,_, �9i.... �nT j-': x S` '•{ "l\ tJ-
- From
.x_ gr
` - il.. '^ .• E'oY- I' ..`�. F"c R, _y e� Wit" s /e �l' "`/y' .
FILL
_�_ FILL AVFoLV''.r-?s, _ .4•.1.. -son E-'s7[' 'fly. .':$
go
b,.5'' _ �.�, e
of s
0k44 Los
}
_.
Illinoisan G y
I I tor. ILL
FAIL
It +.' -e. : i� p :�-� "'�.,- �v�,.`.. @PA,n, i ym _ i `1 �IF ILL- .. kAdi �q;� i �• �4 xt-.APA, in IF •e: C f 4 `solW on
11LotFor I
, IFgo c- "'�--,�• �.ati _ n� ., �,� a.0 F--- 71.. "`r _�'jt. -:..` P"� F� '..*,: Ayl%` ,`'. :1., .el�`p "M1i
Food, I
man I In �- _ Y
a �Ifto,y4 A As,r
r
r "
�Ct %a l r l yAc & :l w r' C'�` rIn
'
i
got,
goiffle
_� °yam
too
- ILL _ILL� r `t1 ,lam �'- +i►:, ds i;F.', -3T ,¢, 'y "P.�, p�." r-r ., r ::Ai �i j •ff .,^Ft q�[ � s." •;# y7'+ w 4aC
SPILLI � .J r. ,:r - -•,'- '•Y +�.r,� ;..xei�tr...• �y,,::i' ,r �r �� -_7!? �'. .F ..\.-'^�. ., 1 ..
on
r
All
tim for soft, X
IF
e
v
In A
4-
FIL
IF
LooLei"' nol.. A IV,'! ' k4a A, C 1All `14' kr �s-L �. ' _ _ - - _-- —
jj Ar sVr got, IF
r - _ e` 1r �V�� emIF IF
u- �T-" r 7 ILL
d
% Ji w.- 1 s iIF i IV�,ry - 5r
— _ —
%
OF av!oF
y -it IF on
-
�`wIs
- _ —_
xso- VAL _
1. �,—y� ILL
r, , i..r�, — mil- Y i�� 't ? '• — _ _�- _ _ _
tion A� �d� yr x, Ang Los
a� _-A -1 onto IF _
�Vion not IF,
� P'
I - IF In I III In Ionic
ILL
',,
+ Folio, ^Y sf , In -
I IF11 - IF
-
p - R , off IF on
— _ - _ _ _
"k ,.
ILLr a,;
y
' J '
r {or x
r <
w IF
a
V%yj r Login.
- -- -
IF
P':
s' _
_ - I son
-
n IF FILL IF
IF
"'on FILL
`
or In
• - .
IF mm` IF on
LIF
IF An Isue.IF too
-
VIA
f-
In son I
in
no IF no on ago
to r on
notion For A LIP
or
IF
I no
Alo no
IF
on,
In ILL
�' 4kOI "It!
;
r R ,
Loop I - — �,

�A
w, A * _ go Aw Ito
IV
Vr.I or
a Age
fog Ilk At I
-7 fffi
Of got
l- dlr
tooke
+" go OPT
'
$"
? 11 Or L to
In
to Age
Fr' f. }erg,: :i
aM ook,Nor
If
of to
If
f
;:1. yvof
7 i.� I got t.
vtore 3 W.
, iy ,t -• To 4
Ilk I
j. ny
goo
.of I dig" ol
ff
7 ell
fee
fee
of
Ago
fellA..- Vogl.
'f ,. All
go
q
off
jo ass.
10 go
Joggle, Ilk
k or
lo:
l g
,..
r
4
ofL..
. ;
II IIo r p u r.to
A
AeI rrJ S{ _
�A ,,,NZ „y,:.:..
two evil, e
a
..for Ago
..•" S .. a. yIf %Ago
.. a ice' _ '•- _ - 9 -
age :..Air
y�
tiAlk If Ito le' �•_ w,
.,.,�`., vs � , A - - ,� woe /q - .e-.sue. � ¢"' _ / ..- _ � % / — �.
�.-
to
1.
A to
gAg
WIF
y4r - _ %/�
- _ ,,, ,y" _ _
j .',
%
Sol
yY' i.. '• G� r""' ,."we flog A ." .-. .r i //'• i - f fAr
sib' jY
e..ol! - - _'
.' _ s^
of
AL 1
of
Ito
L ..i..•`i _ _ _ r pol 1' — /R;`��.� -�''a 'I of'� �•®- .J.. _ "i
µof All I -go6 logo
• .., A :. "� ,�X I. �: s -'•'.OF fee- _ ..mac tgo L Al � r - �' _ !- j�
feel
yi '., _ : P� "� 3._.• Fa . ' �.-,`07*
- /'goo
`-i' ~ sa• 3#�,' . r -j e€• _ ,: r �- x � r 4 -
ba
A I. logo
1 S /
\ q�
a . .a '1- _ 3X , .r. - - - _ go ':✓ Y'Ssr �..' i Vim/ ="<, h 1
getAgpi;
I get
log L,
f Ito
A got
foorl II
AlfA � ., - ,... t * �. /R, g'lo r,jam--:/;It. E- of
p l Ago
fi
IL f `::� g� �- ¢ 'tIto, eeek,l
ell too,
k ; ter-� . ` N,i < op %e f`[ r If pi t f"� < !V � of �' � !�`Ormf—k5 T ILL
{ �- 1
- _ c ," ! 1.r of II
rAge log
Wage sA ker'raw IF Ap
• , �:,•ut� " ' Wool10 got ,,.�". ;-�.t A of
• J rr .
_` _oo
T 1. RA,x
get.
rogg
AWI
rgggggblll� w W 11 ell
f4o'r It
• - _
foll loge
Ammiig
for
Ilk I logo re
?J�i 3 r _to 'Awl
- _ _ a y?e s a " 4 fa��N._Age I �
y
LA folag If fe go" III off
-mot Ilk
�
A of
e look
. _ - of .I goggle IT III If
„ _
I ell logo
All
All- I
go 0 go
Afte _AMIL
-or
off
Af
"" _
/ Tlob I ell
js
6 No
I Awl ell
J� } 4o 1. t . y -
t"far 11 ell
. ,-All
Alto
Af
I% floor IL
se Ago Flow All
411,
!� Jsfox
of
v_
i— .Ago'. * .

J
P
�t Fu!) Pond/ Normai Water Levelj
3 ft. below full pond water le�,ei 4 h. above full pond water level 2 h. additional clearing
if nPrPccary
Existing bank
10 ft. bank Qia
height 0`�
I
Side Vi