20201559 Ver 1_Shoreline Stabilization_20201201

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:
DWR Pre -Filing HANS.pdf 50.97KB
Pre -fling Meeting or Request Date 10/22/2020
ID# 20201559 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 payrrent and requests for pure information here.
Owner Information:
Name:* THOMAS HANS
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
114 Fern Haven Lane
Address Line 2
City
State / Frovince / Region
Mooresville
NC
Fbstal / Zip Code
Country
28117-9489
US

Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name: * TAMARA HAGER
Company Affiliation:* LKN DREDGE & MARINE CONSTRUCTION
Email:* HAGER@LAKEPERMIT. COM
Phone Number:* [phone]
(XXX)XXX-XXXX
Address:* Street Address
PO BOX 5335
Address Line 2
City
State / Province / Region
MOORESVILLE
North Carolina
Fbstal / Zip Code
Country
28117
United States
Asigned and dated copy of the Agent Authorization letter:*
AUTH HANS.pdf 720.11 KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* THOMAS HANS
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 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: HANS TOPO.pdf
Latitude:* 35.623827
288.07KB
Longitude:*-80.919163
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*
HANS SURVEY.pdf 373.98KB
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.)*
HANS PICS.pdf 778.67KB

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:* CRESENT LAND & TIMBER
hclude phasellot number
Directions to site:*
FROM MARSHALL STEAM STATION TURN LEFT ONTO NC HWY
150 GO 4.2 MILES, TURN LEFT ONTO PERTH RD GO 4.0 MILES,
TURN LEFT ONTO FERN HILL RD GO 3.0 MILES, PROPERTY
WILL BE ON RIGHT 114 FERN HAVEN LN
Rease include road narres and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
RESIDENTIAL
Residential, undeveloped, etc.
6. Property Size .71
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
REBURBISH RIP RAP TO SHORELINE FOR STABLIZATION
8. How will the work be done? * r From Land
V 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.)
0
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.)
0
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(number of trees, for instance)
NONE
Sketch: HANS SKETCH.pdf 242.96KB
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:
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:* THOMAS HANS
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201559
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

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
I Attach a photograph of the shoreline/ buffer proposed to be stabilized. (include a scale
Of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: L Nearest Town: & DD'�VI L.J'r
Subdivision name or site address (include phase/lot number): ZL1
Directions to site - please include road names and numbers, landmarks, etc.:
S`E
Latitude (in decimal degrees)�S ! Longitude (decimal degrees) � `O � r -11 � �L�
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 2L i I - —r'
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: tJ o im
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
9. Will work be conducted from land? ❑ From water?
VSJ E 4-4_6� Er:- 'L L t+ � C-1
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: 1Dt�1,1% BY f C7L
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance):
/r
u — t I
Owner/Agent's Signatu * [15A NCAC 02H .0502(f)]
Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

Project
Owner:
{ Print
Print
fSP
R-'N
--
The anaroval is 'Or the purpose and design described in our
aoplirtion is a violation a,'%he 8ulrer RuIE. Si aspeci-ic warfc
Y applic ion_ lrlpacs no- indicated In U,
02H _(7506 and 15A NCAc 028 .024:3(8)1 should be provided in the applicat'rfln.
51, Il1 C,
rees are not a11o,had to '
ee rer loved =rom %one T o; the o"u;; ?r (within 30=�
aRprovad. Exception, those that Minimal sha ins severely undermined along °' `'be = ull pond levarion) unless
p a and slapina 2lon¢ the ir;rmcdiate shoreline is allowed S!� Mediate s,oFeline can b2 removed.
Bench AC 02B _Q7e3{6)7
Benching grading in the ,
LJLrcieris notc'IILJlSle , _:fCe55itilE di bance Qi crQund Cover. [� NCAC 3eac- =s, imper'liaus per— _SA RJ�AC 0?
b _0243 { )a
2re fj Tt,@�fViOrJS rllallCULrgi�S ��C. are nai P-1101N2d inthe bUrier
'V e �i"lision. Tllere ar liniitacian on size fordecks_ r?5A fL
t�niess specirically approved
CACO2S.02f3(4)and (5)I
�It�orl, to be conducted iro
'lr�arif e m land must indite an access a
orridor should be described. ; he a and indicate any gees that a
materral pProv d acc=ss corn+- fe -o be removed. Thy
mU&� 1}E ouzsid2 the buffer. r' �s dor shall be res�oree..
?=3- rVCAC ozi _a5f5� ! S�a-inb, spoil eons r Li-, iCr.
a_and r, �r,CLt�
Storrnw2ter 5 N'C B .02c3 (`), (6), (8)
cannot be piped
dischGr�II p P or channelea ,,-or direct G'iSCrl�Cre tO
she=t 3iov, a u5i bE 8` the natur2l alevazion and dfScharge n� laKe_ �11 C �`I1C:WCa Stor
Qn.,tr r�-u�tar
L non srosivR verncrtias 40 .he 12 ie r 5a 1VC °prior to =nrerrno -he buffer direc-t?d 2S dire L= AC L128.0243 (3), (6)! s or
�l ck,;ti,gledge.;,erL a liloLi1lco far,
<: S
il3dri�h `r�Ui i�r Fii:lc. !' v hereby S�atO LhaL '
nF vdorlc COnducte a ° - i ncvO OEcr1 inTar fined Oi th? Catawba
bl+the i]#vision a, J d rn the LOu"a nO- Alba
V zLCr -,esaurces D+1VP r speci,"itally s�a�ed in she ap lica�
#C�n Sut ri L1112 the cO , 1 1), i5 a V101atlon and sub 2 A tiQn end approved
nS�rLCdon r.Nil1 be lauilt +J.+' 1 t l Lo enforcement. 1]112 dilicc�
ullalit' cer ur-icaziOn and {thin subs' -'
BUiicr antlal cOrll li2ncc e rlCe �A+1�1 Be
il2ier1215. uj-s' — = 2pprOved and it lie+it Oi ille `I h
12n(S) 2nd s:)ecriic2i iail(5) �_
_ , and othersUpportins
.Signature (owRC,-:., - V
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MyTopo
ONLINE MAPSCONTACT US LOGIN
Step 1: Where should your map be centered?
Enter place name or address to find maps available in your area ofinferest.
114 Fern Haven Lane, Mooresville, North Carolina 2811 Hide Map
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Map
Bi"eNJSE3 vi6Cif
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From: TAMARA HAGER ,[e-mail]
Subject: Hans Shoreline pics
Date: Oct 22, 2020 at 6:00:37 PM
To: TAMARA HAGER [e-mail]
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From: TAMARA HAGER [e-mail]
Subject: Hans Pier & boardwalk pics
Date- Oct 22, 2020 at 6:02:07 PM
To: TAMARA HAGER [e-mail]

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Tamara Hager n
704-575-2227
Lake Permit LLC
[e-mail]

ID#* 20201559
Version* 1
Regional Office * Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 10/22/2020
Contact Name*
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
Tamara Hager
[e-mail]
Hans
Thomas Hans
Iredell
Street Address
114 Fern Haven Ln
Address Line 2
aty
Mooresville
Fbstal / Zip axle
28117
Is this a transportation project?* r Yes (' No
State / Rovince / Pegion
North Carolina
Country
United States
Type(s) of approval sought from the DWR:
F 401 Water Quality Certification - W 401 Water Quality Certification -
Regular Express
F- Individual Permit F- Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- No
Do you know the name of the staff member you would like to request a meeting with?
Not needed
Please give a brief project description below.*
Refurbish Rip Rap to Shoreline for stabilization
Please give a couple of dates you are available for a meeting.

Please attach the documentation you would like to have the meeting about.
pdf only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
1 also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
G�
Submittal Date 10/22/2020

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