20201210 Ver 1_Shoreline Stabilization_20201022

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/20/2020 8:03:16 AM (Submittal)
Submit by Montalvo, Sheri A 10/22/2020 9:14:49 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 10/20/2020 8:03 AM

Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to viewthe form.
(First click here is the EPA Clean Water Act,
second click here will be the form Pre Filing Meeting.)
Attach documentation of Pre -Filing Meeting Request here:
DWR Pre -Filing Meeting Request
51.821{B
Form(Small).pdf
Pre -fling Meeting or Request Date 9/18/2020
ID# 20201210 Version
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 * [e-mail]
Rease provide an enail address for payment and requests for more infornation here.
Owner Information:
Name:* David Small
Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx

Mailing Address:* Street Address
21 Erhardt Road
Address Line 2
City
State / Rovince / Fegion
Fleetwood
PA
Fbstal / Zip Code
Country
19522-8961
United States
Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name:* Randy Jordan
Company Affiliation:* Lyfe Marine, Inc.
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Address:* Street Address
19109 W. Catawba Ave.
Address Line 2
Suite 200
City
State / Rovince / Region
Cornelius
NC
Fbstal / Zip Code
Country
28031
United States
Asigned and dated copy of the Agent Authorization letter:*
David Small Agent Auth.pdf 196.15KB
David Small Catawba form.pdf 332.17KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Dave Small shoreline
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.
r Upload File
F Lookup address

Property Address Lookup:* Street Address
601 Stillwater Road
Address Line 2
city
Troutman
Fbstal / Zip Code
28166
Latitude:* 35.642961
State / Province / Pegion
NC
Country
United States
Longitude:*-80.924772
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*
David Small Diagram.pdf 221.58KB
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.)*
David Small photo l.jpg
5.51MB
David Small photo 2.jpg
5.62MB
David Small photo 3.jpg
6.58MB
David Small photo 4.jpg
6.04MB
David Small photo 5.jpg
5.13MB
David Small photo 6.jpg
5.46MB
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:* 601 Stillwater Rd, Troutman NC28166
Include phase/lot nunber
Directions to site:*
77-N to Exit 42 for NC- 115N; turn left onto NC-115 to L onto Autumn
Leaf Rd to L onto Perth Rd. to R onto State Park Rd. to L onto Morrison
Farm Rd. to L onto Willow Point Rd. to L onto Stillwater Rd. 601 is on
the right.
Please 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 w/ existing shoreline and pier.
Pesidential, undeveloped, etc.
6. Property Size .86
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 layer of Class 'B" Rip Rap.
8. How will the work be done?* V 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 w ails, etc.)
522
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.)
87
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)
Grassy yard.
Sketch: David Small Diagram.pdf 221.58KB
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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
o I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online 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');
0 1 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 the Shoreline Stabilization online form.
Full Name:* Randy Jordan
Signature:
I�gG+d ,Toy' ,314

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201210
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

SAMPLE AGENT AUTi-IORLZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO! PARCEL ID: ��� �LA .`fin
STREET ADDRESS -
Please print,
Properly owner:
Property Coiner:
The undersigned, registeted property owners of the above noted property, do hereby authorize
_— Of
(Contrador /,agent) (Nar� consuiting firm)
to act on my behalf and take all actions rKxxssary for the processing, issuance and acceptance of
this Pem, it or certification and any and all standard and special conditions attached.
Property Owners Address (if different than pr2pqrty above):
Telephone: -�
We hereby cer* the above information submitted in this application is true and accurate to tha
€ est 6f our knowledge.
Authorizes! Signature
i7ate:�_ -`\-
Authorized Signature
Date:

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address��`�C���
Contractor/agent:
Print
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 .0S06 and 15A NCAC 02B _0243(8)1
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. [ISA NCAC OR _0243(6)]
Benching and grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243
(01
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)1
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 steal€ be restorer;:. 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 026 .0243(5), (6))
Acknowleclge,,n,& of Notffrcution
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 he
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
Date:
Signature (owner)�,_ �{ ' i U2C

Lake
(At full Pnnd/ Normal Water Level)
Please approximately sketch the following information on this plan, length of shoreline
(Provide dimensions for each item, such as loft x I oo ft)*:
1. All proposed vegetation clearing
I Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rill 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
& Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

Lake
(At full Pnnd/ Normal Water Level)
Please approximately sketch the following information on this plan, length of shoreline
(Provide dimensions for each item, such as loft x I oo ft)*:
1. All proposed vegetation clearing
I Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rill 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
& Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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