20201764 Ver 1_Shoreline Stabilization_20210104

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 51.02KB
Pre -fling Meeting or Request Date 12/30/2020
ID# 20201764 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: * Don Almond
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
15001 Rosemary Way Drive
Address Line 2
city
State / Frovince / Region
Huntersville
NC
Fbstal / Zip Code
Country
28078-4668
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:*
2020-12-30 16.50.44.pdf 333.29KB
2020-12-30 16.50.11.pdf 352.18KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
..............................................................................................................................................................................................................
Project Name:* Don ahnond/refurbish only to existing Rip Rap
State / Province / Region
NC
Country
US
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: A9DD461F-5EF2-46CO-AAD1-
334.15KB
081D40876BA5.jpeg
Latitude:* 35.469270 Longitude:*-80.971160
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*
8F 1 OCAD2-8A9B-40B5-97DC-
2.88MB
008C5D9D9945.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.)*
04AFB9F5-9BD7-4EB8-B385-
105.38KB
47EB72CD8AF8. jpeg
A3528B7F-FB02-4692-B5B6-
107.29KB
B66F66B7D3E8.jpeg
4. Location of the property (where work is to be conducted)
Nearest Town:* Denver
County:* Lincoln
Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address:* 8216 Mallard Rd Denver NC 28037
Include phasellot nunber
Directions to site:*
From NC-16 Bus N Rt on Unity Church 0.2 M
Rt on Graham Rd 0.8 M Stay left on Graham 0.7M
Rt on Captains Way 50 ft
Rt on Mallard Rd. 0.1 M
Rease include road nacres and numbers, landrrarks 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 0.569 AC
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Refurbish to existing Rip Rap only to eroded areas
for shoreline stabilization. All work to be done by
water using barge and long reach
8. How will the work be done?* r From Land
r1 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.)
600 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 walls, 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:*
(number of trees, for instance)
None

Sketch: 15316290-A42D-4C3A-B5F7-
665.83KB
4108E9C85A6B.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:* 20201764
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:
STREET ADDRESS:
Please print. -
Property
Owner:
Property
Owner:
Np 6_ ►J_ -
The undersigned, registered property owners of the above noted property, do hereby
authorize
N p �t�N� M ► , of 1—I�-� ���J �� l�1 � C5-
(Con ctor/AgenE) (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.
Property Owners Address (if different than property above):
V I L-�L—F' NC, C;1!9Z -V
------
Telephone: .-7 C>f" 3 ��9
We hereby certify the above information submitted in this application is true and
accurate tothe best of our knowled

Project
CM�`MA RYPPAlwtlf 2 B. _ � � ul'; DLO- i3ORrVII
Print
oe—TOFOM1
Print
County: _ �( tc
Signature
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Mule. Site specific work should be provided in the application_ [ISA
NCAC tl?ki 0506 and 15A NCAC 02B .0?43(g)]
Trees are not allowed to be removed from Zone 1 of the Buffer (nithin 30 R of the full pond elevation), unless
approved Exception, those trees that arc severely undermined along the immediate shoreline can be removed.
Mrnimal shaping and sloping along the immediate shoreline is allowed. [15ANCAC 02B .0)43(6)]
Benching and ceding in the buffier is not ailovmxl Eacessivz disturbance of ground cover. [15A NCAC 02B
M-43 (6)1
Beaches: impervious patios, impervious wall.7ways_ etc. arc not allowed in the buffer unless specifically
approved by the Division. There are limitation on size for decks. [15ANCAC 02B M743(d) and (6)]
Work to be conducted from land most 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 inust be outside the buffer. [15ANCAC 02H .050? and 15ANCAC 02B .0?tt3 (4),(6), (3)]
Stormnatcr cannot be piped or channeled for direct discharge to the lake_ All constructed storrntvatcr
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flotvat non -erosive velocities to the lake. [15ANCAC MB .0243(07, (6)]
Admorrledgemiva of Arotifrdztion
1, 0 , hereby state that I havoc been informed of the Qtatt ba
Riparian Bnffcr Rule. Any work conducted in the buffer, not spccdfrcally 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 -till be built ttithin substantial compliance and intent of the 401 Water Quality
Certification and BufferRuless, the approved plan(s) and spygrftcation(s), and other supporting materials.
Signature(otrrmcr): Date: J/6- 'r 10,?0
�c'A Iil�}1;

0
�a
J,ttte�i. 16
;enter Q
�a
O�
N pilot��
)wan Is Ford
ountry Club
Westport Golf Club
Westpor
18216 Mallard Rd
1393
1393 L`

n..
�yl
� v u
d
a o ca
a
go E u y r
q� Q . I
H c 0 0 0
030 g °
03
9b
cd
fV

\% 2� � f. � �
Q � `«^« .\� �
w � �l:�t� � y. .
\� S2
�`.:� \� � }� %� � ° -
»c� � d \°� » \ \|
.,
T� f� & m� <
�. »: .,
� �� \
� \\ � � � }� �

Lake
(At Full Pond/ Normal Water Level)
SIc
Elv
Side View

ID#* 20201764
Version* 1
Regional Office * Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 11/17/2020
Contact Name*
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
Terri Kindley
[e-mail]
8216 Mallard Rd Denver NC 28037 Shoreline maintenance
Brendon Almond
Lincoln
Street Address
8216 Mallard Rd
Address Line 2
aty
Denver
Postal/ Zip axle
28037
Is this a transportation project?* r Yes r 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 / Region
NC
Country
Lincoln
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below.*
Maintenance to e)asting Rip Rap
for shoreline 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
Submittal Date 11/17/2020