20200869 Ver 1_Shoreline Stabilization_20200702

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/1/2020 1:13:31 PM (Submittal)
Approve by Montalvo, Sheri A 7/2/2020 10:11:53 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 7/1/2020 1:13 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: *
Robin Koniecmy
Email:*
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Address:*
Street Address
1022 Shoreline Drive
Address Line 2
City
Stanley
P>stal / Zip Code
28164-7737
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 / Pegion
Mooresville
NC
Fbstal / Zip code
Country
28117
(is
Asigned and dated copy of the Agent Authorization letter:*
2020-07-01 13.09.17.pdf 277.95KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 021-1.0502(a) & (b)]
...........................................................................................................................................................................................
Project Name:* Robin Konieczny Shoreline Stabilization
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: 41168DFE-9FA3-418E-9BA5-
7963FDD50OD5. jpeg
Latitude:* 35.445900
Longitude:*-80.960840
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*
6EF51 FAB-623 F-4B41-96FE-
835.98KB
C7650FA6B426.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.)*
1 BD1 A79E-44A4-42DF-AECO-
698.29KB
F64452401EEl.jpeg
4E151520-5C08-4B26-8B3C-
758.1 KB
A681BAD12138.jpeg
4. Location of the property (where work is to be conducted)
Nearest Town:* Lincohiton
County:* Lincoln

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 1022 Shoreline Dr. Stanley, NC 28164
Include phase/lot number
Directions to site:*
177 exit 25 toward Huntersville
Right onto NC-73, W. Sam Furr Road 6.5 miles
Right onto Club Drive 1.3 miles
Right onto Shoreline Drive 0.2 miles
Rease include road names 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 0.68 Acres
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.
All work to be done by water using barge and long reach.
8. How will the work be done? * F 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.)
500
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:*
(number of trees, for instance)
None
Sketch: 9381733B1-C7217-43E3-13926-
834.54KB
29CE770A7053. 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):
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
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:* 20200869
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

I GEMT AUTH0R.7?1-1-10M 1=0�r.7
PROPERTY LEGAL DESMIPT.I<ON:
LOT NO: PLAN NO: PARCEL
ID:
STREET ADDRESS:
0 ?-2, S' P (I C
U911-
Pease print:
Property
Owner: r
Property
Owner:
The undersigned, registered property owners of the above noted property, do hereby
authorize
D L fx do (Q A-X�'
Vcontractor/Agent) {Dame 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 t
accu
d in this application is true and
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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):
11. Signature
Outter/Agenfs Signature- I15A NCAC 02H .0502(Al Date
Agent's signature is valid only if an authorization letter
from the owner is provided.
12. Please appromimately sketch the following information on this plan and provide dimensions for
each item
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/ Norma! Water Level elevation
d. Location of any proposed structures such as buildings, re ' g wal docks, etc.
e. Location of any excavation or dredging beloi t4] 11 rpnd/normal ater Level elevation
O_ 'tl
Full Pond/ Normal Water
Shoreline
Plan View
La
Lakex
(At FullPond/ Nona Wl water Level)
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Tom �
00

�r
150
Lake Norman v
of Catawba
Westport
16
t1022 Shoreline Dr
wesville
Lucia
Mt Mourne
115
A
Davidson
Cornelius
Huntersville
77

Mm
A
Side View
LL
31Lbelow fWl pond Mefl el Oft. abare full pord voter level 2 tt. adGtional clearing
'Ifnecfts
Existing bank
10 ft. hank a
ne�l hr ose
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