20201386 Ver 1_Shoreline Stabilization_20201106

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 11/5/2020 9:13:38 AM (Submittal)
Submit by Montalvo, Sheri A 11/6/2020 3:49:52 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 11/5/2020 9:13 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.
Attach documentation of Pre -Filing Meeting Request here:
Pre -Filing Meeting Request.pdf 414.56KB
Pre -fling Meeting or Request Date 11/5/2020
ID# 20201386 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 err -ail address for payrrent and requests for pure infornation here.
Owner Information:
Name: * Marian and Rick Landis
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
307 Morwood Rd
Address Line 2
City
State / Frovince / Region
Telford
PA
Fbstal / Zip Code
Country
18969-2232
US

Is there an agent working on the
project? *
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:*
Email:
Phone Number:*
Mailing Address:*
F Yes
f^ No
Janice Estep
CBC Stone & Recychng,LLC
[e-mail]
[phone]
(XXX)XXX-XXXX
Address
638 Oakridge Farm Hwy
Address Line 2
City
Mooresville
Fbstal / Zip Code
28115
Asigned and dated copyof the Agent Authorization letter:*
Auth. Form.pdf 224.65KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Landis Property
State / Province / Fbgion
NC
Country
United States
If your project has a formal name please use this. If your project does not hake a formal name, please identify your project by
the owner name and proposed acti\ity (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
Vicinity Maps.pdf
Directions.pdf
Latitude:* 35.660736
424.38KB
1.72MB
232.98KB
Longitude:*-80.955697
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 319.03KB
Buffer form.pdf 380.9KB
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.)*
Shoreline Pics.pdf 2.1MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Statesville
County: * Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: * 306 Clark Cove Rd. Statesville, NC 28677 Lot 19 Old Homestead 1
Include phase&t nun ber
Directions to site:*

610 E Center Ave
Mooresville, NC 28115
Continue to E Statesville Ave
47 s (443 ft)
Head west toward E Statesville Ave
246 ft
Turn left toward E Statesville Ave
197 ft
Take Cornelius Rd, Perth Rd and State Park Rd to Clark Cove Rd/St
Johns Rd in Fallstown
25 min (13.8 mi)
Turn right onto E Statesville Ave
1.1 mi
Slight right onto NC-115 N/N Broad St
Continue to follow NC-115 N
1.4 mi
Turn left onto Connector Rd
0.8 mi
Continue onto Cornelius Rd
2.4 mi
Turn right onto Judas Rd
1.2 mi
Turn right onto Perth Rd
3.0 mi
Turn left onto State Park Rd
3.7 mi
Turn right to stay on State Park Rd
0.1 mi
Turn left onto Clark Cove Rd/St Johns Rd
Continue to follow Clark Cove Rd
Destination will be on the right
2 min (0.8 mi)
306 Clark Cove Rd
Statesville, NC 28677
Rease include road nacres and nurrbers, landaurks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Fiesidential, undeveloped, etc.
6. Property Size 0.88 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Reshape and re -slope shoreline. Install matting and boulder rip rap

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, back fill, excavation, rip rap, retaining walls, etc.)
5' below (1260 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.)
F above (252 sf)
10' x 50' access
corridor (500 sf
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:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201386
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. --1-91— PLAN NO. PARCEL ID:
STREET ADDRESS:
Please print:
Property Owner: MCA—[- la- t:
Property Owner:
The undersigned, registered properly owners of the above noted property, do hereby authorize
of 1
(Contractor / Agent) (Name of consulting fir ) C
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):
•� . _ _ sf\ � rti ,. �. n T
Telephone:(, C
We hereby certify the above information submitted in this application is true and ac-curate to the
best of our knowledge.
Au on ed Signature � Authorized Signature
Date. �U Date:

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Pull Pond/
Normal Water Levu
Shoreline
Lake
(At Full Pond/ Normal Water Level)
I l a.bove zc �5a'
tAo �-ree5 X-r- loVed
.b:> boFV r
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such os 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: SSG 10-2013 Page 3 of 3

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
981071
Project Name/address:_30U���f,,� N, ��.�e . „ „G�ailz'; e mr County: TrtdeJ[
Owner-
' -Print Signatu
Contractor/agent: r-Re_ sAbne t Pecucl; no, _LL C_
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 .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 Notification
I.marl&rl Lamis hereby state that I have been informed of the Catawba
Riparian B ffer 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(s), and other supporting
materials.
Signature (owner): j Date: 1651d0

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