20200828 Ver 1_Shoreline Stabilization_20200625

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/23/2020 6:53:07 PM (Submittal)
Approve by Montalvo, Sheri A 6/25/2020 3:00:58 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 6/23/2020 6:53 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:*
Charles Clontz
Email:*
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Address:*
Street Address
588 Fern Hill Rd
Address Line 2
City
Mooresville
Postal / Zip Code
28117-9491
Is there an agent working on the r Yes
project?* r No
Agent/Consultant Information
Name:* Terri Kindley/Shannon Miller
Company Affiliation:* Lake Norman dredging
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
US

Mailing Address:* Street Address
PO Box 3156
Address Line 2
city
State / Province / Region
Mooresville
NC
Fbstal / Zip code
Country
28036
US
Asigned and dated copy of the Agent Authorization letter:*
2020-06-23 13.14.41.pdf 243.53KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
............................................................................................................................................................................................................................
Project Name:* Charles Clontz/Shoreline stabilization using 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.*
F Upload File
r Lookup address
Upload Map: 009B16EAAD86-4CCE-8C68-
D4EAFBC43360.png
Latitude:* 35.642440
Longitude:*-80.924490
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*
D08871 DO-F23D-46E4-BB38-
831.29KB
CC2A06C513AA.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.)*
DB908319-873C-44EE-8F27-
4AMB
DAA02A98D7F2. jpeg
BBE9C5D9-1245-454B-B8B8-
4.65MB
270AA3F 11D 14.jpeg
4. Location of the property (where work is to be conducted)
Nearest Town:* Fallstown
County:* Iredell

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 629 Stillwater Rd., Troutman NC 28166
Include phasellot nunber
Directions to site:*
177 exit 36 Hwy 150 towards Lincolnton 2.3 miles
Right on Perth Road 6 miles
Left on State Park Road 1.4 miles
Left on Morrison Farm Road 2.1 miles
Left on Willow point Road 0.2 miles
Left on Stillwater Road 0.2 miles
Rease include road narres and nunbers, landrrerks 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 0.84 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Shoreline stabilization 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
V 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.)
640 sq 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, backfill, 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)
None/ work done by water
Sketch: 475 89DFD-5A81-4981-9F79-
888.25KB
D9DFDFF6D9AE.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:
C3� �

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200828
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; � PLAN NO: PARCEL
ID:
STREET ADDRESS:
Please print:
Property
Owner:
Property
Owner:
The undersigned, registered property owners of the above noted property, do hereby
authorize
ILA, of 1
[ ntractor/Agent) F (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:
We hereby certify the above information submitted in this application is true and
accurate to the best of our knowledge.
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Lake Norman
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1629 Stillwater Rd
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Temporary impacts (temporary clearing, construction corridor) in square feet:
10. 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):
I I. Signature
O\xmer/AgenfsSignature 115ANCACO2H.0502tf11 Date
Agent's signature is valid only ifan authorisation letter
from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions jor
each a' All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
C. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level e e
d. Location of any proposed structures such as buildings, retaining walls, docks etc. 1\p��
e. Location of any excavation or dredging below the Full Pond/ Normal Water L vel elevaii
Lake
(At rtra Pond/ Namrer water Levell
Full Pond/
sb}-aP�iINE S
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