20201872 Ver 1_Shoreline Stabilization_20210204

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 49.43KB
Pre -fling Meeting or Request Date 12/8/2020
ID# 20201872 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:* Kelly Quinn
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
20928 Dec ora Drive
Address Line 2
City
State / Frovince / Region
Denver
NC
Fbstal / Zip Code
Country
28037
United States

Is there an agent working on the F Yes
project?* r No
Agent/Consultant Information
Name:* Dean Fisher
Company Affiliation: * Lake Norman Custom Dock & Pile Driving, Inc
Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Address:* Street Address
PO Box 1439
Address Line 2
City
State / Province / Region
Denver
NC
Fbstal / Zip Code
Country
28037
United States
Asigned and dated copy of the Agent Authorization letter:*
20210128100300_001 1.pdf 221.98KB
20210128100300_001.pdf 398.4KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Quinn shoreline
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: 20928 Decora Dr - Google Maps.pdf 272.01KB
Latitude:* 35.497924 Longitude:*-80.887768
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*
DWRplotplan.pdf 98.87KB
DWRdrawing.pdf 1.2MB
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.)*
unnamed (1).jpg 39.91KB
unnamed (2).jpg 56.28KB
unnamed (3) Jpg 37.45KB
unnamed. jpg 37.73KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Cornelius
County:* Mecklenburg
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* 20928 Decora Dr lot number 9
Include phasellot nunber
Directions to site:*
Take NC-73 E. Turn left onto W Catawba Ave. Turn left onto One
Norman Blvd. Turn right onto Knox Rd. Turn left onto Torrence Chapel
Rd. Turn right onto Decora Dr. Property is on the right.
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
Fbsidential, undeveloped, etc.
6. Pro pertySize .64
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Installation and grading of approx 6x66ft along shoreline for RipRap
8. How will the work be done? * m From Land
r 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.)
330 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, backfill, excavation, rip rap, retaining walls, etc.)
726 sq ft
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)
manicured lawn
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
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:* Dean Fisher
Signature:
eA-0eI

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201872
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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 9 PLAN NO.
PARCEL ID: 00174228
STREET ADDRESS: 20928 Decora Dr. Cornelius NC 28031
Please print:
Property Owner: Kelly Quinn
Property Owner: 1 _ cunTC 6
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher _ -- of Lake Norman Custom Dock & Pile Driving, Inc
(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.
Property Owner's Address (if different than property above):
Telephone: [phone] — _----_
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Si ture
_ �_ 2-7' 2 �-------
Date: _ — _ _./

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Quinn shoreline County: Mecklenburg
Owner: Kelly Quinn Ca6r-� J ✓}Cfi S YArvSq__
Print Signature
Contractor/agent: Dean Fisher Dda-vl
Print 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. [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 and grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 026 .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
Kelly Quinn , 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 be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the app
materials. Z
Signature (owner):
n(s) and specification(s), and other supporting
Date: /" Z -7' ? rL

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5 ft rip rap x 66 ft = 330 ft below
760 Access
1 ft rip rap 10 ft access
11 ft x 66 ft = 726 sq ft above
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Contact Name*
Dean Fisher
Contact Email Address*
[e-mail]
Project Owner*
Kelly Quinn
Project Name*
Quinn Shoreline
Project County*
Mecklenburg
Owner Address:*
Street Address
20928 Decora Dr
Address Line 2
aty
Cornelius
Postal / Zip axle
28031
Is this a transportation project?*
(- Yes c: No
Type(s) of approval sought from the DWR:
F- 401 Water Quality Certification - F- 401 Water Quality Certification -
Regular Express
F- Individual Permit F- Modification
W Shoreline Stabilization
Does this project have an existing project ID#?*
(- Yes c: No
State / Province / Pegion
NC
Country
USA
Do you know the name of the staff member you would like to request a meeting with?
Alan Johnson
Please give a brief project description below.*
Installation and grading of approx 6x60ft along shoreline for RipRap with
fabric
Please give a couple of dates you are available for a meeting.
12/8/2020
12/10/2020
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.
• I understand by signing this form that Icannot submit myapplication until 30 calendar days after this pre -filing
meeting request.
• I 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 12/3/2020