20210109 Ver 1_Shoreline Stabilization_20210218

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:
Wells Shorline Request DWR Pre -Filing
51.73KB
Meeting Request Form (3).pdf
Pre -fling Meeting or Request Date 1/15/2021
ID# 20210109 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.
John Wells
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
16600 Birkdale Commons Parkway
Address Line 2
Suite B
City
Huntersville
Rbstal / Zip Code
28078-6181
State / Rovince / Region
NC
Country
US

Is there an agent working on the C Yes
project?* a No
Agent/Consultant Information
Name: * Donna P. Hrko
Company Affiliation: * Lancaster Custom Dock and Lift Systems, Inc.
Email:* donna. lancasterdocks@gmaiL corn
Phone Number:* [phone]
(XXX)XXX-XXXX
Address:* Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
North Carolina
Fbstal / Zip Code
Country
28166
US
Asigned and dated copy of the Agent Authorization letter:*
Wells Signed Authorization Letter.pdf 146.98KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Wells Shoreline Refresh
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
Property Address Lookup:* Street Address
18605 Bluff Point Road
Address Line 2
City
State / Province / Fegion
Cornelius
NC
Fbstal / Zip Code
Country
28031-7961
US
Latitude:* 35.455132
Longitude:*-80.893507
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*

Wells Site Plan Sketches Survey Riparian
913.SSKB
Buffer Form.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.)*
Wells Photographs.pdf
1.03MB
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: * 18605 Bluff Point Road Cornelius, NC 28031 Lot #12
hclude phase/lot nunber
Directions to site:*
From I-77 NB, Exit 28, Left onto W Catawba Ave., Right onto Bluff
Point Road, Property is on the right at end of road.
Aease include road narres and nunbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Pesidential, undeveloped, etc.
6. Property Size .695 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 shoreline, install Mirifi Cloth and Class A Hammer Rock
for stabilization and erosion control Install french drain system needed to
mitigate erosion from frequent wave action generated from wake board
boats over existing rocks undercutting stabilization system. Remove
leaning tree on shoreline as shown in photos.
8. How will the work be done?* 17 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.)
1188 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.)
1094 sf
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)
One tree that is leaning toward lake will be removed. See sketches and
photos.
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:* Donna P. Hrko
Signature:?

Initial Review
Is this accepted into the review
process?*
Project Number:* 20210109
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: 12 PLAN NO:
STREET ADDRESS:
18605 Bluff Point Road
Cornelius, NC 28031
Please print:
Owner: John Wells
Property Owner:
PARCEL ID: 00104126
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko , of Lancaster Custom Dock and Lift Systems, Inc.
(Contractor/Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptanceof this
permit or certification and any and all standard and special conditions attached.
Property Owners Address (if different than property above):
16600 Birkdale Commons Parkway Suite B
Cornelius, NC 28031
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of 14r knowledge.
r\ K
uth rized Signature Authorized Signature
1/15/2021
Date Date

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Water Resources 15A NCAC 02H .0s00 — Water Quality Certification, shoreline stabilization
EN VIRONNEN IAL QUALITY
FORM: 55GP 02-2017
Please approximately sketch the following information on this plan and provide dimensions far
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
La ice
(At Full Pond/ Normal Water Level)
woo d�
C.-
Full Pond/ Normal water Level '
Shoreline Mfg �U9L
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ir or
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Plan View
Lake
fAr Full Pond) N—I waxer L-1) 7Exisfingck
/ 30hx7 ft
3 ft % f50 ft
Full Pondl Normal Water Level
Below full pores NWE
"iho Tne ` —
477 Aa"n
Riprap '
2ft .I50 ft.
Abae wl vone Nw
addlt6w,dltlearing i
if nece58dry
E AMP E
FORM: 55GP 02-2017 Page 1 of 3
Plan View

FORM: 55GP 02-2017 Page 2 of 2

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SIGNED
CAR •.,� Bishop Land Surveying Inc.
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15806 Brockway Drive, Suite 200-F
° Q Huntersville N.C. 28078
SEAL Phone [phone]
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CATAwRA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 1 l
b aunty: -11ec"
Owner: +� of of or.�Gli c�5, G 31
Print
Contractor/agent: Y' 519 to
Print ` 5ignature
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. [1.5A NCAC 02B .0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243
(s)]
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), (g)]
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
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 (DWI), 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 BufferMules, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner); f — 1 5 — n
Date: GLJ

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ID#* 20210109
Version* 1
Regional Office * Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 1/15/2021
Contact Name* Donna P. Hrko
Contact Email Address* donna. [e-mail]
Project Name* Wells Shoreline Refresh
Project Owner* John David Wells
Project County* Mecklenburg
Owner Address: Street Address
18605 Bluff Point Road
Address Line 2
aty State / Province / Pegion
Cornelius NC
Postal / Zip axle Country
28031 United States
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.*
Install Mirifi Geotech fabric on shoreline. Install Class A Hammer Rock
along shoreline for 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
Submittal Date 1/15/2021