20211532 Ver 1_Shoreline Stabilization_20211025

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 view the form.
Attach documentation of Pre -Filing Meeting Request here:
Pre -Submittal Meeting Request Form.pdf 1.03MB
Pre -fling Meeting or Request Date 9/20/2021
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]
Please provide an email address for payment and requests for more information here.
Owner Information:
Name: *
Sally B. Gambrell, Trustee
Email: *
[e-mail]
Phone Number: *
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
5625 Fairview Road
Address Line 2
City
State / Province / Region
Charlotte
NC
Postal / Zip Code
Country
28209-3619
us

Is there an agent working on the project?* Yes
No
Agent/Consultant Information
............................................................................................................................................................................
Name: * Janice Estep
Company Affiliation:
Email: *
Phone Number:
Mailing Address:*
CBC Stone & Recycling, LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
638 Oakridge Farm Hwy
Address Line 2
City
Mooresville
Postal / Zip Code
28115
A signed and dated copy of the Agent Authorization letter:
Auth. Form.pdf 619.54KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Gambrell Shoreline
State / Province / Region
NC
Country
United States
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.*
Upload File
Look up address
Property Address Lookup: * Street Address
150 Travis Point Drive
Address Line 2
City
State / Province / Region
Mooresville
NC
Postal / Zip Code
Country
28117-5520
US
Latitude: * 35.538974
Longitude: *-80.881717
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 1.12MB
Buffer Form.pdf 1.09MB

Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/O/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.)*
Shoreline Pics.pdf 10.79MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Mooresville
County: * Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* Lot 1 Travis Point
Include phase/lot number

Directions to site:
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
11 s (197 ft)
Turn right onto E Center Ave
2 min (0.5 mi)
Turn left onto S Church St
1 min (0.4 mi)
Follow E Wilson Ave and US-21 S to Alcove Rd
9 min (3.7 mi)
Turn right onto E Wilson Ave
1.5 mi
Turn left onto US-21 S
2.2 mi
Use the left lane to continue on Williamson Rd
387 ft
Follow Alcove Rd, Templeton Rd and Camino Real Rd to Travis Point Dr
4 min (2.1 mi)
Turn left onto Alcove Rd
0.5 mi
Turn right onto Templeton Rd
0.9 mi
Turn left onto Camino Real Rd
0.6 mi
Turn left onto Travis Point Dr
Destination will be on the left
351 ft
150 Travis Point Dr
Mooresville, NC 28117
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:
Residential
Residential, undeveloped, etc.
6. Property Size 1.626 acres
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 to replace existing wall
8. How will the work be done?* From Land
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.)
Y below (570 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 (190 sf) 10'
x 50' access
corridor (500 sf
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:*
(number of trees, for instance)
Grass buffer, no trees removed. Minimal disturbance to buffer. Access
from adjacent property with same owner.
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $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");
a 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:* Janice Estep
Signature:
rk'%tibr y9'.�v'+k��-�o,eMaaP'
Submittal Date: 10/21/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211532 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Alan Johnson: eads\adjohnson I
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
• Need Fee - send electronic notification
• $240.00
$570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. -j--. PLAN NO, _... PARCEL ID:
STREET ADDRESS. _15o r[�`+ ��n'►o�} w
Please print:
Property Owner: -_ Sara. el V1 GO,nn6M5 j
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
J&v)'kCe L �Sif�___— , of ��L not FLR W 1', ng L.LC
(Contractor / Agent) (Name of consulting firm) .j
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: 1q — g o q_ f o Qq LQ
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature _ Authorized Signature
Date: q - ILA - at Date:

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Lake
(At Full Pori d/ Normaj Water level)
3' he 1ouJ , i q0
Full fond/
NormalWater Level
nwm
Shoreline
�bo�e X t�l�' l�o trees rl.moucc!
wiU�'
Access �rorn ad uCE�4
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Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining wails, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

C„ 11AVIB PF'UP All MAN BUFFER NOTIFICATION FORM
Project Marneladdress: (5C) 1 A\J U O'k�k �� Mob I©b 5'J' \L X�jCo�ar�tya
©weer. 91 nrn In -p,o l 1�, i�H w n i ton- _ r'2 d'I Z. all, I
Print
Contractor/agent- (
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, 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 Notificaition
1, i&m6( t 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.
I1%/L�%i

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a

Contact Name *
Contact Email Address*
Project Owner*
Project Name *
Project County*
Owner Address:*
Is this a transportation project?*
Janice Estep
[e-mail]
Sally B. Gambrell, Trustee
Gambrell Shoreline
Iredell
Street Address
150 Travis Point Dr.
Address Line 2
city
Mooresville
Fbstal / Zip Code
28117
r Yes r No
Type(s) of approval sought from the DWR:
i 401 Water Quality Certification - i 401 Water Quality Certification -
Regular Express
r Individual Permit r Modification
W Shoreline Stabilization
State / Rovince / Dion
NC
Country
us
Does this project have an existing project ID#?
r Yes r 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 to replace existing 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.
Y 1 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 *
('7 1r1 61e
Submittal Date 9/20/2021