20201775 Ver 1_Shoreline Stabilization_20210106

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
51.59KB
Newlin.pdf
Pre -fling Meeting or Request Date 11/18/2020
ID# 20201775 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 *
Owner Information:
Name: *
Email:*
Phone Number:*
Mailing Address:*
[e-mail]
Rease provide an er ail address for payment and requests for more infornation here.
Lake Norman Cottage LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
4926 Hackamore Road
Address Line 2
City
Greensboro
Fbstal / Zip Code
27410-9319
State / Rovince / Fbgion
NC
Country
US

Is there an agent working on the r Yes
project?* r No
Agent/Consultant Information
Name:* DonnaP. Hrko
Company Affiliation: * Lancaster Custom Dock and Lift Systems, Inc.
Email:* donna. lancasterdocks@gmaiLcorn
Phone Number:* [phone]
(XXX)XXX-XXXX
Address:* Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
NC
Fbstal / Zip Code
Country
28166
US
Asigned and dated copy of the Agent Authorization letter:*
Lake Norman Cottage LLC (Newlin) Signed
148.59KB
Agent Authorizaiton.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Newlin Shoreline Stabilization
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.
f Upload File
r Lookup address
Property Address Lookup:*
Latitude:* 35.631863
Street Address
397 Stumpy Creek Road
Address Line 2
City
Mooresville
Fbstal / Zip Code
28117-8462
State / Province / Plegion
NC
Country
US
Longitude:*-80.899839
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*

Lake Norman Cottage LLC (Newlin) Property
1.31MB
and Project Information.pdf
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.)*
Lake Norman Cottage LLC (Newlin) Photos
715.19KB
of Shorehne.pdf
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:* Crescent Land +Timber Corp. Section 14 Lot #126
Include phasellot number
Directions to site:*
From I-77 NB, Exit 36, Left onto NC-150 WB (River Highway), Right
onto Perth Road, Left onto Stumpy Creek Road, Property is on the left
just before the road "T"s into Liva Lane.
Rease include road nacres 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 1.291 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Shape and slope approximately 190' of shoreline. Install mirifi. geotech
fabric and class "b" rip rap for stabilization and erosion control.
8. How will the work be done? * I7 From Land
V 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.)
950 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, backfill, excavation, rip rap, retaining walls, etc.)
500 sf construction
corridor
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
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):
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:* DonnaP. Hrko
Signature:}7

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201775
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: 125
STREET ADDRESS:
397 Stumpy Creek Road
PLAN NO:
Mooresville, NC 28117
Please print:
Pro a Owner: Lake Norman
Property Owner:
PARCEL ID: 4639-50-5310
e LLC (J. Morris Newlin
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko
(Contractor/Agent)
of Lancaster's Dock and Lift Systems, Inc.
{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):
4926 Hackamore Road
Greensboro, NC 27410
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
A �
Au onz d ignature Authorized Signature
Date12/22/2020
Date

rIF_
State of North Carolina
Department of Environment and Natural Resources Division of Water Resources
Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
ENVkRONMEfV f AL QUA L' l i FIRM: 55GP 02-2017
Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Full Pond/ Normal Water Level
Shoreline
Plan View
FORM: 55GP 02-2017
La ke
(At Full Pond/ Normal Water Level)
U
iP P
5[ ZI6-��
�,t]rr►C�n� �
r
Full Pond/ Normal Water Level
' — n oreTne — —'
2 R.x 150 ft
addi0t wl clew rFre
` If n 4—ry
Lake
[A[ Full P—V 14 A Water level]
Riprap
Existing Dock
/�1onx7n
3 fix 1108
BA folk pond)NWt
�
arzxfsnrr
�Abo full pond/ NWL
I'x tqo• .�- IgoSip
Page 1 of 3
Plan View

bar, jj
! 5 n ec�
V e.r ❑ r
under C."+'I n av"eQ6
Lake
(At Full Pond/ Normal Walter Level)
5�-)o&owQI l � �ko2bcote fall-p c,,id
CD
3 ft. below full pond water level 4 ft. above full pond water level
Existing bank
10 ft. bank
height
FORM: SSGP 02-2017 Page 2 of 2

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
L.S"t' C NorVXan 1�0 # e`
Project Name address: Newli n .J�Dr i J� k1l a County; r
] l'LnV-V i 4, %IA �I?.n in r 1 �1j11 !tV[ il�
Owner: '� 1 f
Pri
Contractor/agent:
Print
Sienatur
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 Rule. Site specific work should be provided in the application. 115A
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 NICK 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 023.0243(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 Notifrcvtion
1,��'-"'`�S.�,. l 1 �f _ 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 he
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plans) and specification(s), and other supporting
materials.
Signature (owner): Date: 12- .&Zo

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4925 HACKAMORE RD. CREEHSBORO NC 27419
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&CONNEC # VI�
WEB HCrRING
1 1
Iredell
Printed January 05, 2021
See Below for Disclaimer
1,#
Addresses
A, Infrastructure
'
34_ i
` NonResidential Use
' Residential Use
Streets
— Interstate
s
Ramp
US Hwy
i
— State Hv�y
Y
Main Road
R
Local Road
Residential
17s-l_7475
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4,,38_R-ft3r:.ih
Private
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Parcels Nooks
Parcels
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Parcel Labels
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—
City Limits
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Lake Norman
_ Iredell Couniyline
NC Counties
A3. •
- : ' 25 7Feet
he maps prepared far this website are generated from recorded deeds, plats, and ocher public records. Users of these maps are hereby notified that the information
provided herein should be verified. Iredell County assumes no legal responsibilities for any of the information contained on this site. Users are advised that the use of
ny of this information is at their own risk. All maps on this site were prepared using a 10005(- Grid based upon the North Carolina State Plane Coordinate System from
he 1983 North American Datum. The delinquent real property tax overlay is updated monthly- The information presented is not intended to be used or relied upon a
fficial notice of tax liens- For additional information re ardin q delis uent taxes, contact the Iredell County Tax CoIlector's Office.

Iredell County
Property Data
Parcel Number: 4639505310.000
Inquiry Date: 1/5(2021
Disclaimer: While every effort is made to keep information provided over the internet accurate and up-to-date, the County does not certify
the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping data
herein, or for their use or interpretation by the User.
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Owner/Property Into
Tax Account Number: 80075400
Old Parcel Number: 1702SD4000A126
Owner Name: LAKE NORMAN CQTTAGE LLC
Mailing Addre$S: 4926 HACKAMORE RD GREENSBORO NC 27410
Property Location: STUMPY CREEK RD
Lot Number: 126
Legal Description; CRESCENT LAND+TIMBER CORP S14 PB13-32
Municipal Information
Township Code: 17
City Code: 00
Neighborhood Code: 17223
Value information - Current Year Property. Record Card (PRE}
Building Value: 252760
Other Building Features: 17646
Land Value: 341250
Tax Assessed Value: 611650
Deferred: 0

Land Information
- Register of Deeds
Online Search
Date Recorded
Document Type
Deed Book Deed Page
Plat Book & Page
Land Area Land Type Zoning
20200925
WD
2737 1454
13-32
1.35 AC RR
Tax information
Exemption
Tax Code 1
Tax Code 2
Tax Code 3
Tax Code 4 Tax Code 5
Null
C ADVLTAX
Null
FR06ADVLTAY
Null Null
Current Zoning Contact Info.
Iredell County
7D4.878,3118
Harmony
7D4.878.3118
Love Valley
704.878.3118
City of Statesville
7D4,878,3575
Town of Troutman
704.528.7600
Town of Mooresville
704,662.7D40
Village of Davidson
704.892.7591

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ID#* 20201775
Version* 1
Regional Office * Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 11/18/2020
Contact Name* Donna P. Hrko
Contact Email Address* donna. [e-mail]
Project Name* Newiin Shoreline Stabilization
Project Owner* Lake Norman Cottage LLC
Project County* Iredell
Owner Address: Street Address
397 Stumpy Creek Road
Address Line 2
aty
State / Rovince / Pegion
Mooresville
NC
Fbstal / Zip axle
Country
28117
USA
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
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below.*
Shape and slope shoreline for installation of geotech fabric and Class
B rip rap for shoreline stabilization and erosion control.
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
0
Submittal Date 11/18/2020