20201226 Ver 1_Shoreline Stabilization_20201023

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/22/2020 9:11:29 AM (Submittal)
Submit by Montalvo, Sheri A 10/23/2020 2:05:44 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 10/22/2020 9:11 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:
Meeting Request Form.pdf 440.93KB
Pre -fling Meeting or Request Date 9/21/2020
ID# 20201226 Version 1
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 email address for payment and requests for pure information here.
Owner Information:
Name: * Natalie Hollis
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
P.O. Box 1385
Address Line 2
city
State / Frovince / Region
Cornelius
NC
Rbstal / Zip Code
Country
28031
United States

Is there an agent working on the
project?*
Agent/Consultant Information
......................................................................................................
Name: *
Company Affiliation:*
Email: *
Phone Number:*
Mailing Address:*
a Yes
O No
Janice Estep
CBC Stone & Recycling, LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
638 Oakridge Farm Hwy
Address Line 2
City
Mooresville
Postal / Zip Code
28115
Asigned and dated copyof the Agent Authorization letter:*
Auth. Form.pdf 209.37KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Hollis Property
State / Province / Fegion
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 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
r Lookup address
Upload Map: Survey.pdf
Vcinty Maps.pdf
Directions.pdf
Latitude:* 35.493993
515.63KB
1.83MB
261.65KB
Longitude:*-80.903818
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.pdf 328.71KB
Buffer Form.pdf 358.07KB
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.)*
Shoreline pics.pdf 2.9MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Cornelius
County:* Mecklenburg
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 20830 Bethelwood Ln. Cornelius, NC 28031 PID# 00183113-A
hclude phasellot nunber
Directions to site:*
610 E Center Ave
Mooresville, NC 28115
Take E Statesville Ave to E Center Ave
1 min (0.2 mi)
Head west toward E Statesville Ave
246 ft
Turn left toward E Statesville Ave
197 ft
Turn left onto E Statesville Ave
0.1 mi
Turn right onto E Center Ave
1 min (0.4 mi)
Continue on S Church St to S Main St
2 min (0.6 mi)
Turn left onto S Church St
0.5 mi
Turn right onto College St
0.1 mi
Continue on S Main St. Take NC-115 S, Langtree Rd and I-77 S/US-21 S
to Bethel Church Rd in Cornelius
14 min (8.4 mi)
Turn left onto S Main St
1.2 mi
Continue onto NC-115 S
2.1 mi
Turn right onto Langtree Rd
1.1 mi
Use the left 2 lanes to turn left to merge onto I-77 S/US-21 S

3.1 mi
Take exit 28 for US-21 S toward Catawba Ave/Lake Norman/Cornelius
0.2 mi
Keep right at the fork, follow signs for Lake Norman and merge onto W
Catawba Ave
0.8 mi
Continue on Bethel Church Rd. Drive to Bethelwood Ln
4 min (1.5 mi)
Turn right onto Bethel Church Rd
0.9 mi
Turn right onto Bethelwood Ln
Destination will be on the right
0.6 mi
20830 Bethelwood Ln
Cornelius, NC 28031
Rease include road narres and nurrbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Undeveloped lot
Residential, undeveloped, etc.
6. Property Size 1.084 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Install Redi Block wall to replace existing wall and install class "B" rip rap
at base of wall. Install TN Crab Orchard steps.
8. How will the work be done?* W 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.)
4' below (400 sf)
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.)
l' above (100 sf)
10' x 50' access
corridor (500 sf of
temp. impact)
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 buffer, no trees removed, minimal disturbance to buffer.
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):

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:' Janice Estep
Signature:
ti�e¢:rc�^�1'rr �i1TxasF� ,�1/rllr

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201226
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: QQ 163 i 13 ,A
STREET ADDRESS: 0
Please print:
Property Owner: N a4-ca 1 c oil i5 -- -„_ - - - -
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
S" of �'�ne A QW [ I nq ) _i ('
(Contractor / Agent) (Name of consulting fir )
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):
s �r
Telephone: ItA I a
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: Y-/0 - a0�2, 0
Date:

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(At Full q�rjnal Water Level)
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4 fir, iir". •
Normal Water Lsal�rrr �� �� ir��� srf M� �f 11
Shoreline
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Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 10 ftx 1oOft)*:
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

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Narne/address: p d80311
County:
Owner:
Print Signature
Contractor/agent: _'„2, 9 rune g --94Prt 1 -11 rV% I I P A
Print '-' J' %)Sinature
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 026 ,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 Notification
l 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 Certification and Buffer Rules, the approved plan(s) and specification($), and other supporting
materials.
Signature (owner): . � � Date: 9 — ltu _ .201

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