20200951 Ver 1_Shoreline Stabilization_20200723

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/22/2020 5:03:22 PM (Submittal)
Approve by Montalvo, Sheri A 7/23/2020 11:06:37 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 7/22/2020 5:03 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 email address for payment and requests for more information here.
George and Phyllis Stubbens
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
1244 Arbor Rd
Address Line 2
Apt. 502
city
Winston Salem
Fbstal / Zip Code
27104
r Yes
r No
Randy Jordan
Lyfe Marine
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Frovince / Region
NC
Country
United States

Mailing Address:*
Street Address
19109 W. Catawba Ave.
Address Line 2
Suite 200
City
Cornelius
Fbstal / Zip Code
28031
Asigned and dated copy of the Agent Authorization letter:*
Stubbins Agent Auth.pdf 120.95KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Stubbins Shoreline
State / Province / Region
NC
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. *
f Upload File
r Lookup address
Property Address Lookup:* Street Address
333 Doohe Road
Address Line 2
Latitude:* 35.589593
City State / Province / Fbgion
Mooresville NC
Fbstal / Zip Code Country
28117-5801 US
Longitude:*-80.900174
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*
Stubbins Diagram.pdf 145.5KB
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.)*
Stubbens photo l.jpg 4.39MB
Stubbins Photo 2.jpg 4.34MB
Stubbins-bushes photo.jpg 6.53MB
4. Location of the property (where work is to be conducted)

Nearest Town:* Mooresville
County:* Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 333 Doolie Rd Mooresville NC 28117
Include phase/lot nunber
Directions to site:*
77-N to Exit 36 to Left onto Hwy 150 to Left onto Doolie Rd.
333 is on the left
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
Fbsidential, undeveloped, etc.
6. Pro pertySize 1
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Push down existing Rip Rap, shape the bank, install Geo-tech fabric,
install new Class 'U' Rip Rap along the 184 lineal ft. of shoreline. Remove
1 shrub on the left side of property.
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, back fill, excavation, rip rap, retaining walls, etc.)
1,472
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.)
184
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 yard
Sketch: Stubbins Diagram.pdf 145.5KB
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
o $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certifythat:
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")

• 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:* Randy Jordan
Signature:
1?a14d1,TOI b1O14

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200951
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:
—3en1I —AAr
, C-
Please print:
Property Owner;
Property Owner:
undersigned, registered property owners of a above noted property, do herebyauthorizi�
(C./Agent) (Name of eonsutdng 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 aft standard and special conditions attached.
Property Owners Address (if different than property alllnrre):
�A C o
Telephone: 7d�-- &&3 - as.GQ
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Autiorixed Mignature Authfiecl Signature
7-15--202-0 7- j
Date Date

La ke
(At Full Pond/Normal Water Level)
Fi
Norm
S
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as loft x 10o ft)*:
I. All proposed vegetation clearing
Z. Location of rip rap ❑r fill to be placed above the Full Pond/ Normal Water Level elevation
I Location of rip rap ❑r 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
f. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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La ke
(At Full Pond/Normal Water Level)
Fi
Norm
S
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as loft x 10o ft)*:
I. All proposed vegetation clearing
Z. Location of rip rap ❑r fill to be placed above the Full Pond/ Normal Water Level elevation
I Location of rip rap ❑r 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
f. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3