20200856 Ver 1_Shoreline Stabilization_20200630

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/29/2020 1:02:38 PM (Submittal)
Approve by Montalvo, Sheri A 6/30/2020 10:37:27 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 6/29/2020 1:02 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: *
Mark Hess
Email:*
mhess3829@gmaiLcom
Phone Number:*
[phone]
(xxx)xxx-xxxx
Address:*
Street Address
277 Orchard Park Dr.
Address Line 2
City
Bermuda Run
Fbstal / Zip Code
27006
Is there an agent working on the r Yes
project?* r No
Agent/Consultant Information
Name:* Darren Stevenson
Company Affiliation:* Stevenson Marine and Recovery
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
Davie

Mailing Address:*
Street Address
459 Stillwater Rd.
Address Line 2
city
Troutman
Fbstal / Zip Code
28166
Asigned and dated copyofthe Age ntAuthorization letter:*
hessagent_converted.pdf 1.15MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Hess Rip Rap Stabilization
State / Province / Fegion
NC
Country
Iredell
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 Look up address
Upload Map: hessmap.jpg
Latitude:* 35.624164
iWFILTA -151]
Longitude:*-80.921508
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*
hessdia.jpg 1.09MB
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.)*
hesspic. jpg 1.36MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Troutman
County:* Iredell
Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address: * Crescent land and timber lot 100 section 15 book 14 page 11
Include phasellot nunber
Directions to site:*

Hwy 77 to exit 36, West on hwy 150, Right on Perth Church Rd. Left on
Fern ITill Rd. Right on Fern Haven Lane. House number 150 on the right
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 House with wooden seawall and pier.
Fbsidential, undeveloped, etc.
6. Pro pertySize 0.72
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Place rip rap in front of existing wooden seawall that is failing.
8. How will the work be done?* PF From Land
r From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
1434
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.)
478
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)
There is no vegetation along shoreline above existing wooden seawall
Sketch: hesssketch.jpg 1.03MB
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):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
o $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")
a I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the INC General Statutes
(the "Uniform Electronic Transactions Act');
a I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
a I intend to electronically sign and submit this form.
Full Name:* Mike Bailey
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200856
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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. I�k9 PLAN NO. PARCEL ID: �`�' / /VS I. 666
STREET ADDRESS: , A.1 %�/ �G id/ ell
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
(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:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorize S natur
Date:
Authorized Signature
Date:

6/2/2020 150 Fern Haven Ln - Google Maps
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Send to your Share
phone
Photos
https://www.google.com/maps/place/150+Fern+Haven+Ln.+Mooresville,+NC+28117/@35.6387785,-80.3588446,12z/data=!4m5!3m4! 1 sOx885153a27... 112

Full Pond/
Normal Water Level
Shoreline
Lake
(At Full Pond/ Normal Water Level)
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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

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