20200886 Ver 1_Shoreline Stabilization_20200708

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/7/2020 3:12:03 PM (Submittal)
Approve by Montalvo, Sheri A 7/8/2020 8:47:42 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 7/7/2020 3:12 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.
Primary Contact Email *
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:*
[e-mail]
Rease provide an enail address for payrrent and requests for rrore inforrration here.
Edge Water - HOA Davidson - Steve Galleher
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
P.O.Box 4810
Address Line 2
City
Davidson
Rbstal / Zip Code
28036
a Yes
d No
Saundra B Mosteller
Dale & Beth Lake Use Permit Service
[e-mail]
[phone]
(xxx)xxx-xxxx
/ Province / Region
NC
Country
United States

Mailing Address:*
Street Address
988 Clear Creek Circle
Address Line 2
city
Lincolnton
Fbstal / Zip Cbde
28092
Asigned and dated copy of the Agent Authorization letter:*
Agent Form.pdf 575.21KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
............................................................................................................................................................................................................
Project Name:* Edge Water - HOA Davidson - Steve Galleher
State / Province / Region
North Carolina
Country
United States
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 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.
r Upload File
r Look up address
Property Address Lookup:*
Latitude:* 35.505100
Street Address
301-372 Northwest Drive
Address Line 2
City
Davidson
Fbstal / Zip Corte
28036
State / Province / Region
NC
Country
US
Longitude:*-80.868232
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*
Page 3.docx 139.35KB
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.)*
Picture. jpeg 875.4KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Cornelius
County: * Davidson

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* North View Harbor
Include phasellot nunber
Directions to site:*
get on I-277S, follow 1-77N to Goodrum Rd in Davidson, take exit 30
from I-77N continue on Goodrum Rd to your destination in Lemley
Rease include road naves and nunbers, landnarks 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 2.554
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
take up concrete walkway and area backfield then planted in grass -
fescue, rip -rap redo along shoreline
8. How will the work be done?* 17 From Land
17 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 w alls, etc.)
500 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.)
500 ft
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 -fescue
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):
$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
• I intend to electronically sign and submit this form.

Full Name:* Saundra BMosteller
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200886
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
-Y LEGAL DESCRIPTION:
I PLAN NO.
PARCEL ID:
ADDRESS: _. .301-372 Northwest Drive, Davidson, NC 28036
Owner: Steve Galleher Edgewater HOA) Northylew 1jaitgr — Property Manager
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Beth Mosteller of Dale.& Beth's Lake Use Permij Service
(ContracbDr / Agent) (Name of consulting firm)
to ad 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):
Steve Gaileher- PropgU Manager
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: Date:

State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10-2013
Shoreline Stabilization Application Form
La ke
(At Full Pond/Normal Water Level)
0000000000000000000000000000000000000000
1111111111111111111111111111111111111111
�� � 1111111111111111111111111111111111111111
i 1111111111111111111111111111111111111111
_ 1111111111111111111111111111111111111111
500 feet to follow contour of shoreline,
one foot above full pond,
and 3-4 feet below full pond
Edge Water — HOA Davidson
Steve Galleher
301-372 Northwest Drive
Davidson, INC 28036
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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