20200100 Ver 1_Shoreline Stabilization_20200805

Action History (UTC-05:00) Eastern Time (US &Canada)
Stiibmit by Anonymous User 8/4/2020 10:19:56 AM (Submittal)
Approve by Montalvo, Sheri A 8/5/2020 11:01:40 AM (Non -DOT -Approver)
• The task was assigned to Montalvo, Sheri A 8/4/2020 10:20 AM

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 errail address for payrrent and requests for nnre inforrration here.
Mary Welborne
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
21415 Country Club Drive
Address Line 2
�Y
Cornelius
R�stal /Zip Code
28031
r Yes
l' No
Christina Campbell
CBC Stone &Recycling, LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
State / FYovince /Region
NC
Country
US

Mailing Address:* Street Address
638 Oakridge Farm lIighway
Address Line 2
Mooresville
Fostal /Zip Code
28115-7947
Asigned and dated copy of the Agent Authorization letter:*
Agent authorization form.pdf 171ICF3
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* WelborneProperty
State / Rovince / F�gion
NC
Country
US
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.*
F Upload File
C' Look up address
Upload Map: plat Map l.pdf 65.S1KB
Maps 4.pdf 1.07MB
Riparian buffer form l.pdf 253.58KB
Latitude:* 35.503507 Longitude:*-80.885792
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*
Site Plan l.pdf 211.31KB
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.)*
Pictures l.pdf 628.33KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Cornelius
County: * Mecklenburg
Lake/ river/ ocean adjacent to Lake Norman
property:

Subdivisions name or site address:* Country Club Shores, #2 -Lot 8
hclude phase/lot nunber
Directions to site:*
610 E Center Ave
Mooresville, NC 28115
Head west on E Center Ave toward Cedar St
1 min (0.5 mi)
Continue on S Church St to S Main St
2 min (0.6 mi)
Continue on S Main St. Take NC-115 S, Langtree Rd and I-77 S/iJS-21 S
to Torrence Chapel Rd in Cornelius
12 min (7.8 mi)
Continue on Torrence Chapel Rd. Drive to Country Club Dr
4 min (1.7 mi)
21415 Country Club Dr
Aease include road nacres and nurrbers, landrrarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
l�sidential, undeveloped, etc.
6. Property Size 0.353
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Take down and rebuild to repair section of existing VA Fieldstone wall.
Install TN Crab Orchard cap on repaired section of wa1L Install black
boulders at the foot of wall for entire existing wa1L
8. How will the work be done?* I7 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.)
3' below (300 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.)
1' above (20 sq ft)
10' x 50' access
corridor (500 sq ft
of temp. access)
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nurrber of trees, for instance)
Grass buffer, no trees removes, minimal disturbance to buffer, existing
shoreline wa1L Neighbors consent form to access property is attached
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):
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 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")
o 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");
o 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:* Christina Campbell
Signature:
!� �rr.�r.� f'a+a�.s�iFr rJA'nry �.&awr,�

Initial Review
Is this accepted into the review
process?
Project Number:* 20200100
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
C'Yesallo
Version:* 1
Alan Johnson:eads\adjohnsonl
Mooresville Regional Office - [phone]
(' No Payment Needed
l" Fee Received
C' Need Fee -send electronic notification
r $240.00
f $570.00

AGENT AUTHORIZATION FORM
PROPERLY LEGAL DESCRIPTION:
LOT NO. PLAN N0. PARCEL ID: �j��b 1 \ (fly-{ �{q
STTtEET ADDRESS: .� 1y1 C kr (' \ _ �
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"ryW����1 /D�W,�n�eC: 11`n C1A `f1� `F�nr��.
P' "Y" �) vnllCr:
The undersigned, registered property owners of the above noted Property, do hereby authorize
(Contractor / Agenq (Name of consulting finn)����--
to ad on cry behalf and take all actions necessary for the processing, issuance and aaeptance of
this permit or certifimtion and any and all standard and spedal conditions attached.
Property Owner's Address (if different than property above):
Telephone: ��`�1-tlo'��a`� Oi�.SZ`-�-(olg-rJOQy
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized ����/l// Atrthorized Sgnature
Date: �_Ir1-7i72D pate:

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7/29/2020
CBC Stone &Recycle LLC Mail -Access- lot permission
M Gmail
Access- lot permission
2 messages
Info Account <[e-mail]>
To: [e-mail]
Good afternoon,
Info Account <[e-mail]>
Wed, Jul 29, 2020 at 12:57 PM
I Ash Ganatra, authorize CBC Stone and Recycling to use my property at 21419 Country Club Drive, Comelius NC to
gain access to 21415 Country Club Drive, Comelius NC in order to rebuild their shoreline and move boulders. The time
frame for the permit process is approx. 8 weeks. The actual work is an estimated 2/3 weeks depending on the weather.
October Sth would be an approx. start date.
Kindest Regards,
Christina Campbell
CBC Stone and Recycling, LLC
Natural Green Scapes Services, LLC
CBC Grading and Hauling, Inc.
636 Oakridge Fann Hwy
Mooresville, NC 28115
Office 704-660-5111
Fax [phone]
Email [e-mail]
Office Hours:
Monday -Thursday 7 - 4
Friday 7 - 3:30
Ash Ganatra <[e-mail]>
To: Info Account <[e-mail]>
Cc: Neil Welbome <[e-mail]>
I am okay with this lot access.
Thank you.
Ash Ganatra
Shree Jalaram Management Corp
9711 Moss plantation Ave, NW
Concord NC 28027
Ash. gene tra@jalaramcorp. com
704-907-4776 Cell
704-707-3369 Office
704-788-6665 Fax
On Jul 29, 2020, at 12:57 PM, Info Account <[e-mail]> wrote:
[quoted text hidden]
Wed, Jul 29, 2020 at 1:12 PM
https://mai I. gong le.com/maillu/Olik=65a76e4&48ffiview=pl&search=a118permihid=thread-a°'o3Ar4679320203650482759&simpl=msg-a�o3Ar-63990147... 1 /1

Lake
(At Fu II Pond/ Normal Water Level)
` C��b n r xi � Q. wa.l �
1 !xl«ux loo , n:��- 3. hdow �( ab Se �l
bouldef r'? f ��1
Full Pond/a,} base �
Normal Water Level
Shoreline i ,
I o.bove X a0 C�lorl Luo.11 re�'i2
Nat,S e \J
�iokCa¢s Cerho��.
M.n;m�� ��S��.C�t_t
� h��e� .
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 10 ft x 100 ftJ*:
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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CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project
Owner: 1��'-hgPJ� /"tc/t/v
Print
Contractor/agent: 4,(' Yh.� i
Print
C.ocne.�: u-S �IJC_
�Rn2\ county: 1'\e.c�\ic�i[]c.ac�
Signature
The approval is for the purpose and design described in your application. Impacts not indicated in [he
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A NCAC
02H .0506 and 1SA NCAC 028 .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ff of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be removed.
Minimal shaping and sloping along the immediate shoreline is allowed. (15A NCAC 02B .0243(6))
Benching, 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. [SSA 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 must 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(S), (6)]
Acknowledgement of Notification
I, n,.,t 4�e��1nc tee_ ,hereby state that I have been informed of the Catawba
Riparian Buffer ule. Any work conducted in the buffer, not specifically stated in the application and approved
by [he Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction wilt be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plans) and specification(s),ond other supporting
materials.
Signature(owner): � � i�'G�/CQ✓/ /��--a��r Date: �l ��O'��"�
J