20200902 Ver 1_Shoreline Stabilization_20200710

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/9/2020 3:41:18 PM (Submittal)
Approve by Montalvo, Sheri A 7/10/2020 12:01:03 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 7/9/2020 3:42 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:*
Acousticmikeb@gmaiI. corn
Please provide an email address for payment and requests for rmre information here.
Mike Butkovic
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
101 Island Ridge Drive
Address Line 2
city
Statesville
Fbstal / Zip Code
28677-2097
a Yes
d No
Terri Findley/Shannon Miller
Lake Norman dredging
[e-mail]
[phone]
(xxx)xxx-xxxx
/ 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
28117
US
Asigned and dated copy of the Agent Authorization letter:*
2020-07-09 15.17.04.pdf 314.54KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
.............................................................................................................................................................................................................................................
Project Name:* Mike Butkovic/ New ShorelineStabilization 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.*
6 Upload File
r Look up address
Upload Map: OCBFOCA7-D381-49A2-9EE7-
213.93KB
5BFDOE23A7E7. jpeg
Latitude:* 35.665340 Longitude:*-80.963730
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*
384B0965-EB43-4080-974E-
3.69M13
E8F780878165.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.)*
AFFE3824-5038-40DF-94DB-
974.08KB
1E97D6DA16C2.jpeg
67B8CD27-DC2A 4EFE-9ACC-
3.11MB
536448062F25. 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:* 282 Windemere Island Road Statesville NC 28677 Lot 28
hclude phase/lot nunber
Directions to site:*
I-77 exit 42 NC — 115N/US-2lN 3.2 m
Left on Talley St. 2.1 m
Left on Monbo Road 2.1 M
Slight left E. Monbo Rd. 0.6 M
Left on Heronwood Rd 0.1 M
continue straight Windemere Isle Rd 0.6 M
Rease include road narres and nunbers, landr arks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Undeveloped
Pesidential, undeveloped, etc.
6. Property Size 0.52 AC
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
New 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.)
480 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: 4C991313AA-407-41E8-AC55-
3.72MB
346F37BBA4F5.jpeg
12A8CFF9-5DDB-4771-91 D2-
1.01MB
F0608A47BE5B.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
• I intend to electronically sign and submit this form.
Full Name:* TerriKindley
Signature: a �

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200902
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

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Project
Owner:
Contrac
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A
NCAC 02H .0506 and I SA NCAC 02B .0243(8)1
Trees are not allowed to be removed from Zone I of the Buffer (within 30 It of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be remov
Ivhnimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)] ed.
Benching and grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B
.0243(6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically
approved by the Division. There are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. (I 5A NCAC 02H .0502 and 15A NCAC 02B .0243 (4). (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges most be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive velocities to the lake. [ 15A NCAC 02B .0243(5), (6)]
Acknowledg�em�ent
ojNatijeation
1,) KE 34 � hereby state that I have been informed of the Catawba
L /panan Buffer Role. Any work conducted in the buffer, not specifically stated in the application and approved
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water Quality
Certification and Buter Rules, the approved plan(s) and specif'"fion(s), and other supporting materials.
Signature (owner): „ eil _ e p
Date:Nc9-03QQ
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