20211236 Ver 1_Shoreline Stabilization_20210818

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 233 Cape August Pl.pdf 966.18KB
Pre -fling Meeting or Request Date 8/26/2021
ID# 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: * Gary Livermore
Email: * garylivermore@att. net
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
1057 Peninsula Dr
Address Line 2
City
State / Frovince / Region
Belmont
NC
Fbstal / Zip Code
Country
28012-8678
US

Is there an agent working on the f Yes
project?* r No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* 233 Cape August Pl.
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
Upload Map: 233 Cape August Place Directions. pdf 850.78KB
Latitude:* 35.156127 Longitude:*-81.037211
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*
233 Cape August Place site plan.pdf 467.83KB
233 Cape August Place site plan2.pdf 1.67MB
Please use the diagram at the link below:
https://edocs.deq. nc.gov/Wate rResou rces/0/edoc/616616/Shore I i ne % 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.)*
233 Cape August Place pics.pdf 13.87MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Belmont
County: * Gaston
Lake/ river/ ocean adjacent to Lake Wylie
property:
Subdivisions name or site address:* McLean -South Shore Lot 22
Include phasellot nunber
Directions to site:*
SEE MAP
Aease include road narres and numbers, landnarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Heavely wooded Residential Homesite
Pesidential, undeveloped, etc.
6. Pro pertySize .92
Acres

7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
We only have 35' of shoreline that can have any Rip Rap. We are sure
that installing Rip Rap along that part of shoreline will help with further
erision and loss of trees.
8. How will the work be done?* 17 From Land
r 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 w alls, etc.)
Maybe 17 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.)
980
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)
Lots of 1" to 2" trees to be removed. We have 3-4" trees, 1-6" cedar and
1-12" Beaver damaged tree close to where dock will have to start.
Sketch: 233 Cape August Place Agent Authorization &
1.65MB
Buffer.pdf
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):
0 $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:* Randall S Clawson
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20211236
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

Submission Completed
- 6/1E12021
DWR Pre -Filing Meeting Request Farm
Randall S Clawson
Contact Name*
[e-mail]
Contact Email Address
Project Owner*
Gary Livermore
233 Cape August Place
Project Name*
Project County *
Gaston
Owner Address: *
Street Address
1057 Peninsula Dr.
Address Line 2
city
Belmont
Postal I Zip Code
28012
Is this a transportation project?*
Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Individual Permit
Shoreline Stabilization
Does this project have an existing project ID#?
Yes No
State / Province f Region
NC
Country
Gaston
401 Water Quality Certification - Express
Modification
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 and include location information. *
Vacant Residential lot that needs partial shoreline stabilization done and buffer clean up.
Lot is located in McLean Sub. in Belmont
By digitally signing below,) certify that 1 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.
112
https://edocs.deq.ne.gov/Forms/Form/Submit

Submission Completed
6/1 E'2021
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.
ing
Your project's thirty -day clock started upon receipt
Yo ipwilolf receive veis pnotificationlwhen. you n receive the thirty -day hasaedxpired, meeting
dyou
location and time if a meeting is necessary.
can submit an application.
Signature *
Submittal Date 6/16/2021
https://edocs.deq.nr-.gov/Forms/Form/Submit 2/2

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: Q V PLAN NO:
STREET ADDRESS:
Please print:
Property Owner:
Property Owner:
PARCEL ID:
3 3 Cea 0,9- 4,4 � S Ig c e
rc
The undersigned, registered property owners of the above noted property, do herebyauthorize
Randall Clawson
of Clawsons Pile Driving and
Construction
(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 Owners Address (if different than property above):
I v 5 :1
Telephone: 7d o _ ` —20/15
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Authorize nature
& I n\ t
Date
Authorized Signature
Date

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: 1?33 �4/J-� u _f ���a County: fc��
Owner:
Print
Contractor/agent: Cis
Print
Signature
ature
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 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 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
b C wA-trf , 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 approved plan(s) and specification(s), and other supporting
materials.
Signature (owner): Date: /0

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