20201074 Ver 1_Shoreline Stabilization_20200824

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/24/2020 10:07:55 AM (Submittal)
Approve by Montalvo, Sheri A 8/24/2020 12:12:57 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 8/24/2020 10:09 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 enail address for payrrent and requests for rrore inforrration here.
Alan D & Cynthia Kushner
[e-mail]
[phone]
(xxx)xxx-xxxx Address
125 Mainview Drive
Address Line 2
City
Lincohiton
Rostal / Zip Code
28092
a Yes
d No
Beth Mosteller
Dale & Beth Lake Use Permit Service
[e-mail]
[phone]
(xxx)xxx-xxxx
/ Rovince / Region
North Carolina
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 543.63KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Alan D Kushner
State / Rovince / Region
North Carolina
Country
United States
If your project has a formal name please use this. If your project does not ha),e 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:* Street Address
702 Stonemarker Road
Address Line 2
City
State / Province / Region
Mooresville
NC
Fbstal / Zip Code
Country
28117
US
Latitude:* 35.517878
Longitude:*-80.943917
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*
vicinity.docx 1.9MB
plat.docx 1.02MB
catawba rip buffer form.pdf 845.02KB
Deed.pdf 409.59KB
dredge spoil form.pdf 511.17KB
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.)*
pictures. docx 49.78MB
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:* 705 Stonemarker Road Mooresville NC 28117
Include phase/lot nunber
Directions to site:*
from 526 S. Church St Charlotte NC, get on I-77 N to NC1100 Brawley
School Rd in Davidson, take exit 35 from I-77 N, follow NC1100 to
Blarney Lane
Aease include road nacres and nunbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
residential
Fbsidential, undeveloped, etc.
6. Property Size 1.47
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
due to wave action 172.4 stabilization and dredge 1,107.04 cubic yards
for new dock
8. How will the work be done?* 17 From Land
V 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.)
172.74
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.)
172.74
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: Abbreviated PCN shoreline page 3.docx 141.44KB
Dock Dredge Area.pdf 449.21KB
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 certify that:
a 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:* BethMosteller
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201074
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

LOT NO.
STREET
AGENT AUTHORIZATION FORM
LEGAL DESCRIPTION:
PLAN NO. PARCEL ID: 4624195098
702 Stonemarker Road, Mooresville NC 28117
Please print:
Property Owner: Alan D Kushner
Property Owner: Cynthia Kushner
The undersigned, registered property owners of the above noted property, do hereby authorize
Beth Mosteller of Dale & Beth's Lake Use Permit Service
(Contractor / Agent) (Name 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 Owner's Address (if different than property above):
Telephone':
We hereby' certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized ignature Authorized Signature
Date:' / 0 a o Date:

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Project Name/ad
Owner:
CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
County: Iredell
Print Signature
Contractor/agent: Beth Mosteller a ct i 6
Print Signature
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 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft 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. [15A 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(5), (6)]
Acknowledgement of Notiftcotion
I, Alan D & C nthia Kushner hereby state that I have been
informed of the Catawba Riparian Buffer Rule. 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 Certificatio nd Buffer Rules, the approved plan(s) and specification(s), and other
supporting materials.
Signature (owner): Date:
I II

Type: CONSOLIDATED REAL PROPERTY
Recorded: 1/3/2020 4:36:55 PM
Fee Amt: $1,092.00 Page 1 of 4
Revenue Tax: $1,066.00
Iredell County, NC
Ronald N. Wyatt Register of Deeds
BK 2669 PG 775 - 778
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: S I,066.00
Parcel Identifier No. 462419-5098 Verified by County on the day of 20_
By:
Mail/Box to: McNaujzlit & Clements PLLC 118 Morlake Dr., Suite 100-A Mooresville NC 28117
This instrinnent was prepared by: MeNaught & Clements PLLC 118 Morlake Dr., Suite 100-A Mooresville NC 28117
Brief description for the Index: LOT 176 SEC 6
THIS DEED made this 3Wi clay of December 2019 , by and between
GRANTOR
Calvin S. Kelbaugh, Jr., Single and
Holly S. Brock, Single
35C Planifield Drive
Shelby, NC 28150
GRANTEE
Alan D. Kushner and wife,
Cynthia ICuslnier
208 Chuckwood Road
Mooresville, NC 28117
Enter in appropriate block for each Grantor and Grantee: name, mailing address, and, if appropriate, character of entity, e.g.
corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include singular,
plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by
these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot, parcel of land or condorniniurn unit
situated in the City of Mooresville Township, Itedell County,
North Carolina anti more particularly described as follows:
See Exhibit "A" and Exhibit'B" attached.
Parcel No.: 4624-19-5098
PropertyAddress: 702 Stonemarker Road, Mooresville, NC 28117
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2562 page 647
All or a portion of the property herein conveyed _ includes or X does not include the primary residence of a Granter.
A map showing the above described property is recorded in Plat Book 14 page 26
Page 1 of 2
NC Bar Association Form No. 3 (D 1976, Revised © 1977. 2002, 2013 This standard form has been approved by:
Printed by Agreement with the NC Bar Association— 1981 North Carolina Bar Association —NC BarPorm No. 3
submitted electronically by "MCNaught & Clements, PLLC - Mooresville"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Iredell County Register of Deeds.
Book: 2669 Page: 775 Page 1 of 4

TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and apprutenances thereto belonging to the Grantee in fee
simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the same in fee
simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against the lawful
claims of all persons whomsoever, other than the following exceptions:
Easements and restrictions of record, Ad valorem taxes.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoin as f the clay and year first ve written.
By:.
Print/Type Name &
SEAL
(Entity Name) rint/Type Name: n S. k Abaiilt
SEAL
Print/Type me: Nnllj S. R�rrk
By: (SEAL)
Print/Type Name & Title: Print/Type Name:
By, (SEAL)
Print/Type Name & Title: PrinVType Name: _
State of North Catulina — - County or City of Irredell _
I, the undersigned Notary Public of the County or City of Tredell_ _ and State aforesaid, certify that
Calvin S. Kelbaugh, Jr., Single and Holly S. Brock, Single _ personally appeared before me this day and acknowledged the due
execution of the foregoing instrumen: for the put -poses therein expressed. Witness my h d and Notarial stamp or seal this 30th clay of
December 20 19�
i/11 IQUE
CpT�1 YUF
,LIN� 0 t
1psdell County
My Commission Expires: orth Carollne NotaryPublic
(Affix Seal) My Cammissiosr 1__X lres Q16I2023 Notary's Printed or Typed Name
State of - County or City of
I, the undersigned Notary Public of the County or City of and State aforesaid, certify that
personally appeared before me this clay and acknowledged the due
execution of the foregoing instrument for the purposes therein expressed. Witness my hand and Notarial stamp or seal this clay of
, 20.
My Conunission Expires:
(Affix Seal)
Notary's Printed or Typed Name
otary Public
State of - County or City of
I, the undersigned Notary Public of the County or City of and State aforesaid, certify that
personally came before me this day and acknowledged that
he is the of , a North Carolina or
corporation/limited liability company/general partnership/limited partnership (strike through the
inapplicable), and that by authority chdy given and as the act of such entity, he signed the foregoing instrument in its name on its
behalf as its act and deed. Witness my hand and Notarial starnp or seal, this day of , 20_.
My Commission Expires:
(Affix Seal)
Page 2 of 2
NC Bar Association Form No. 3 01976, Revised 01977, 2002, 2013
Printed by Agreement with (lie NC Bar Association — 1981
otauy Public
Notary's Printed or Typed Name
17ris standard form has been approved by:
North Carolina Aar Association — NC Bar Form No, 3
Book: 2669 Page: 775 Page 2 of 4

Exhibit "A"
Parcel I D:4624-19-5098
Being situated in the city of Mooresville, Davidson Township of Iredell County, North Carolina and more
particularly described as follows;
BEGINNING at an marked existing concrete monument which is the northwestern shared corner of the
property now or formerly owned by Stephen L. Hankins and Susan S. Hankins and described in Deed
Book 1248, Page 1549 and labeled as Lot 175 on the survey referenced therein; thence S 83-12-00 E
249.69 feet to a point and placed pin; thence S 10-11-00 E 149.63 feet to a point and placed pin; thence
S 4-02-28 E 92.97 feet (Radius 434.98) to a point; thence S 2-5-00 W 21.71 feet to a point and placed pin;
thence N 83-55-00 W 33.24 feet to a point and placed pin; thence N 53-08-29 W 128.15 to a point and
exiting iron pin; thence N 74-18-18 W 65.97 feet to a point; thence S 79-02-00 W 52.49 feet to a point;
thence N 63-25-00 W 53.13 feet to a point; thence S 86-29-00 W 67.12 feet to a point and placed pin;
thence N 24-52-00 E 5 feet to a point; thence N 24-52-00 E 197.10 feet to a point at the existing
concrete monument and puce of BEGINNING; identified as Lot 176 of the Recreation Lots Section 6 of
plat book 14, page 26 and containing 1.47 acres, more or less, as shown on a survey by Michael R.
Bowden (L-3811), of Bowden Surveying & Mapping recorded contemporaneously herein at the Register
of Deeds Office for Iredell County and referenced here as EXHIBIT "B."
THIS MAP MAY NOT BE A CERTIFIED SURVEY AND HAS NOT BEEN REVIEWED BY A LOCAL GOVERNMENT
AGENCY FOR COMPLIANCE WITH ANY APPLICABLE LAND DEVELOPMENT REGULATIONS AND HAS NOT
BEEN REVIEWED FOR COMPLIANCE WITH RECORDING REQUIREMENTS FOR PLATS.
Book: 2669 Page: 775 Page 3 of 4

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Book: 2669 Page: 775 Page 4 of 4

DREDGE SPQIk DISPQSAL FORM
Project Name/Oddress: Alan D & Cynthia Kushner County: Iredell
Location Address: 702 Stonemarker Road. Mooresville NC 28117
Parcel #: 4624195098
Parcel/lot size Lot 176 Size 1.47
Disposal area required (sq ft and/or acreage) will be placed on left side fo property at drive on Stonemarker
road
Acknowledgement of Notification
1, Alan D & Cynthia Kushner am aware that the site must adhere to all state
regulations and rules regarding sediment and erosion control and water quality. And give permission for
Name of Individual and Company
to dispose of their dredge material at the above stated
Owner: Alan; D & Cvnthit
Print
Date: ^-,1,611 -a 0 _?,
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoil site
Signature

"Ilk
vN-4

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
172.74 to follow contour of shoreline,
one foot above full pond,
and 3-4 feet below full pond
Dredge 1,107.04 cubic yards
Alan D & Cynthia Kushner
705 Stonemarker Road
Mooresville, INC 28117
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

two
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