20201469 Ver 1_Shoreline Stabilization_20201203

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 Meeting Request Form.pdf 50.88KB
Pre -fling Meeting or Request Date 12/1/2020
ID# 20201469 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 email address for payrrent and requests for pure information here.
Owner Information:
Name:* Ronald W.Mack
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
301 Ridgeway Drive
Address Line 2
city
State / Frovince / Region
Greensboro
NC
Fbstal / Zip Code
Country
27403
Us

Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name: *
Terri Kindley/Shannon Miller
Company Affiliation: *
Lake Norman Dredging
Email:*
[e-mail]
Phone Number:*
[phone]
(xxx)xxx-xxxx
Address:*
Street Address
PO Box 3156
Address Line 2
City
Mooresville
Fbstal / Zip Code
28117
Asigned and dated copy of the Agent Authorization letter:*
2020-12-01 16.30.38.pdf 259.11KB
2020-12-01 16.30.38.pdf 259.11KB
Link to: Sample Agent Authorization Form
State / Province / Region
NC
Country
US
Project Information [15A NCAC 02H .0502(a) & (b)]
........................................................................................................................................................................................................................................................................................
Project Name:* Ronald Mack/ Maintenance to existing Rip Rap for shoreline stabilization
If your project has a formal name please use this. If your project does not haw 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: 0803DACD-A8D5-4272-87D2-
241.87KB
D88468EOA19D.jpeg
Latitude:* 35.589050 Longitude:* 80.921470
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*
3 FA54048-508E-48E8-888F,
635.74KB
15284AEEAFB2.jpeg
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.)*
788DF402-A490-495E-A123-
5.56MB
056D2D2867D3. jpeg
60B55465-4BA7-49DB-AFEO-
4.95MB
CE07E155FDCA. jpeg
4. Location of the property (where work is to be conducted)
Nearest Town:* Mooresville
County:* Iredell
Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address:* 189 Asbury Circle Mooresville NC 28117
Include phaseAct nunber
Directions to site:*
I-77 Exit 35 Brawley school Road WW 3.4 miles
Right on Blume Road 0.9 miles
Left on Beaten Path Road 1.3 miles
Straight onto Asbury Circle 300 ft slight right 250 ft
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 1.153 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Maintenance to existing Rip Rap shoreline for shoreline stabilization
to bear and eroded areas.
All work to be done by water using barge and long reach.
8. How will the work be done?* r From Land
17 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.)
1000 sq ft
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 w alls, etc.)
None
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)
None/ by water

Sketch: A34A25E8-64F6-47A6-820E-
3AMB
D6BB5DF40541.jpeg
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
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:' Terri Kindley
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201469
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: ( PLAN N0:
STREET ADDRESS:
LA R\`f c- c-L_�
Please print-:
Property
owner:�-
Property
Owner:
PARCEL
ID:
The undersigned, registered property owners of the above noted property, do hereby
authorize
(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.
Proper<+j Gt7ners Address (if different Uhan property above):
Telephone: � `� ' � _---S'
We hereby certify the above information submitted in this application is tree and
accurate tot a nest of our lmowledge'
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LOT NO: ( PLAN N0:
STREET ADDRESS:
LA R\`f c- c-L_�
Please print-:
Property
owner:�-
Property
Owner:
PARCEL
ID:
The undersigned, registered property owners of the above noted property, do hereby
authorize
(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.
Proper<+j Gt7ners Address (if different Uhan property above):
Telephone: � `� ' � _---S'
We hereby certify the above information submitted in this application is tree and
accurate tot a nest of our lmowledge'
Cf'114��

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Lake Norman
150 Airpark
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ID#* 20201469
Version* 1
Regional Office * Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 10/14/2020
Contact Name*
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
Terri Kindley
[e-mail]
189 Asbury Circle Mooresville NC
Ron Mack
Iredell
Street Address
189 Asbury Circle
Address Line 2
aty
Mooresville
Postal / Zip axle
28117
Is this a transportation project?* r Yes (' No
Type(s) of approval sought from the DWR:
* 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
* Individual Permit F Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- No
State / Province / Pegion
NC
Country
Irdell
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below.*
Shoreline Stabilization to e)asting Rip Rap in bare and eroded
areas. All work to be done by water using barge
and long reach.
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
Submittal Date 10/14/2020