20211332 Ver 1_Shoreline Stabilization_20210903

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water QualityCertification, Shoreline Stabilization
FORM SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TINE
I. Applicant Information
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 view the form.
Attach documentation of Pre -Filing Meeting Request here:*
Pre -Submittal Meeting Request Form.pdf 1.95MB
pdf only
Pre -fling Meeting or Request Date* 8/3/2021
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 *
Owner Information:
Name:*
Email: *
Phone Number:*
Mailing Address:*
[e-mail]
Rease provide an email address for payrrent and requests for rrore information here.
Anthony Falbo
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
17704 Jetton Green Loop
Address Line 2
aY
Cornelius
Rbstal / Zip Code
28031-8882
State / Rovince / Region
NC
Country
US

Is there an agent working on the
project?*
Agent/Consultant Information
Name:*
Company Affiliation:*
Email: *
Phone Number:*
Mailing Address:*
F Yes
r No
Janice Estep
CBC Stone & Recycling, LLC
[e-mail]
[phone]
()oo()-
Street Address
638 Oakridge Farm Hwy
Address Line 2
City State / Province / Region
Mooresville NC
Fbstal / Zip Code Country
28115 United States
Asigned and dated copy of the Agent Authorization letter:*
Auth. Form.pdf
pdf only
Link to: Sample Agent Authorization Form
1.11MB

II. Project Information
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Falbo 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
C' Look up address
Property Address Lookup:*
Latitude:*
35.476932
Street Address
19829 Bustle Road
Address Line 2
City State / Bovine / Region
Cornelius NC
Fbstal / Zip Code Country
28031-7569 US
Longitude:* -80.917165
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*
Site Plan.pdf
Buffer Form.pdf
pdf only
Please use the diagram at the link below:
2.13MB
1.81 MB
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.)*
Shoreline Pics.pdf 25.61MB
pdf only
4. Location of the property (where work is to be conducted)
Nearest Town:*
County: *
Lake/ river/ ocean adjacent to
property:*
Cornelius
Mecklenburg
Norman
Subdivisions name or site address:* Lot 7 Diane Shores
Include phase/lot nurrber
Directions to site:*

610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
13 s (197 ft)
Turn right onto E Center Ave
2 min (0.5 mi)
Continue on S Church St to S Main St
2 min (0.6 mi)
Turn left onto S Church St
0.5 mi
Turn right onto College St
0.1 mi
Continue on S Main St. Take NC-115 S, Langtree Rd and 1-77
S/US-21 S to Meta Rd in Cornelius
17 min (9.7 mi)
Turn left onto S Main St
1.2 mi
Continue onto NC-115 S
2.1 mi
Turn right onto Langtree Rd
1.1 mi
Use the left 2 lanes to turn left to merge onto 1-77 S/US-21 S
3.1 mi
Take exit 28 for US-21 S toward Catawba Ave/Lake
Norman/Cornelius
0.2 mi
Keep right at the fork, follow signs for Lake Norman and merge
onto W Catawba Ave
1.1 mi
Turn right onto Jetton Rd
1.0 mi
Follow Meta Rd to Bustle Rd
2 min (0.6 mi)
Turn right onto Meta Rd
0.1 mi
Continue straight to stay on Meta Rd
0.1 mi
Turn left onto Bustle Rd
Destination will be on the left
0.3 mi
19829 Bustle Rd
Cornelius, NC 28031
Rease include road narres and nurrbers, landmarks etc.

5. Describe the existing land use or condition of the site at the time of this application:*
Residential
Fssidential, undeveloped, etc.
6. Property Size 0.609
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Install a VA Fieldstone wall with cap on un-stabilized section of
shoreline and install VA Fieldstone rip rap at base of wall
8. How will the work be done?*
rJ 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 walls, etc.)
4' below(172 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, back fill, excavation, rip rap, retaining walls, etc.)
1' above (43 sf)
10' x 50' access
corridor (500 sf of
temp. impact)
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nurrber of trees, for instance)
Grass buffer, no trees removed, minimal disturbance to buffer
Sketch: pdf only

Sign and Submit
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");
o I 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:*
Signature:*
Janice Estep

DWR Pre -Filing Meeting Request Form
Contact Name *
Contact Email Address*
Project Owner*
Project Name*
Project County*
Janice Estep
[e-mail]
Anthony Falbo
Falbo Shoreline
Mecklenburg
Owner Address:* Street Address
19829 Bustle Rd.
Address Line 2
City State / Bovine / !Region
Cornelius NC
Fbstal / Zip Code Country
28031 US
Is this a transportation project?* C Yes 6' No
Type(s) of approval sought from the DWR:
I— 401 Water Quality Certification - fl 401 Water Quality Certification -
Regular Express
r Individual Permit r Modification
fJ Shoreline Stabilization
Does this project have an existing project ID#?*
r Yes ( No
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. *
Install a VA Fieldstone wall with cap on 43' of shoreline. Install VA
Fieldstone rip rap at base of wall.
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 I cannot submit my application 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
8/3/2021