20201709 Ver 1_Shoreline Stabilization_20211006

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
56.62KB
approval.pdf
Pre -fling Meeting or Request Date 11/9/2020
ID# 20201709 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:*
mic haelburkhard@att. net
Rease provide an er ail address for payment and requests for more infornation here.
ADAMS CHRISTOPHER
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
242 Oak Tree Rd
Address Line 2
City
Mooresville
Fbstal / Zip Code
28117-9129
State / Rovince / Fbgion
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
Michael Burkhard
Burkhard Environmental Consulting
[e-mail]
[phone]
(XXX)XXX-XXXX
Address
21326 Bethel Church Rd
Address Line 2
City
Cornelius
Fbstal / Zip Code
28031
Asigned and dated copyof the Agent Authorization letter:*
Signed Agency Agreement.pdf 1.11MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Adams Shoreline
State / Province / Fbgion
NC
Country
United States
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 acti\ity (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: Location Map.pdf 227.22KB
Latitude:* 35.585137 Longitude:*-80.904138
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*
Topographic Survey 424 Oak Tree
480.4KB
Road_201223.pdf
Shoreline Sketch RR.pdf 661.87KB
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.)*
Shoreline Photos for Permit.pdf 814.97KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Mooresville
County:* Iredell
Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address:* CRESCENT LAND+TIMBERCORP Phase S9
Include phase/lot nunber
Directions to site:*
Go W on Brawley School Rd take R on Oak Tree Rd go approximately
1.2 miles subject site on R
Rease include road narres and nunters, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
This is a single family lot on Lake Norman
Residential, undeveloped, etc.
6. Property Size .77 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
The shoreline presently is stabilized with Rip -Rap, we are requesting
approval to add additional Rip -Rap to replace what has washed down into
the lake. The fabric in places are exposed and our goal is to replenish the
shoreline Rip -Rap to have a stable shoreline.
8. How will the work be done?* r From Land
17 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.)
1080 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.)
1728 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:*
(nunber of trees, for instance)
Buffer consist of small trees, shrubs and grass. There is a 15" Tulip
Poplar (Liriodendron tulipifera) located at the top of the existing RR
shoreline at the dock which will need to be removed.
Sketch: Existing Vegetation.pdf 714.02KB
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:* Michael W Burkhard
Signature:
Submittal Date: 10/6/2021

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201709
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