20211622 Ver 1_Shoreline Stabilization_20211108

Submission Form
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]
Please provide an email address for payment and requests for more information here.
Lori Mehen/David Brooks
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
242 Shoreline Loop
Address Line 2
City
Mooresville
Postal / Zip Code
28117-7452
Is there an agent working on the project?* - Yes
O No
Agent/Consultant Information
...................................................................................................
Name: *
Company Affiliation:
Email: *
Phone Number:*
Randy Jordan
Lyfe Marine, Inc.
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
US

Mailing Address:*
Street Address
19109 W. Catawba Ave.
Address Line 2
Suite 200
City
Cornelius
Postal / Zip Code
28031
A signed and dated copy of the Agent Authorization letter:
Mehen Brooks Agent Auth.pdf 127.68Y-B
Mehen_Brooks Catawba Riparian.pdf 434.6KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Mehen/Brooks 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
242 Shoreline Loop
Address Line 2
City
Mooresville
Postal / Zip Code
28117-7452
Latitude: * 35.541042
State / Province / Region
NC
Country
US
Longitude: *-80.898758
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*
Mehen Brooks diagram.pdf 2.27MB
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.)*
Mehen_Brooks Photo l.pdf 6.35MB
Mehen Brooks Photo 2.pdf 4.35MB
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:* Imperial Point/ Bay View
Include phase/lot number
Directions to site: *
77N to Exit 35 ----> Brawley School Rd. to left onto Stutts Rd to right
onto Shoreline Loop. 242 is on the right.
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, undeveloped
Residential, undeveloped, etc.
6. Property Size .46
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Shape the bank, install geo-tech fabric, install Class "B" Rip Rap along the
123 lineal feet of shoreline for stabilization.
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.)
1107
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.)
123
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)
Vacant lot, graded
Sketch: Mehen_Brooks diagram.pdf 2.27MB
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');
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:* Randy Jordan
Signature:
Submittal Date: 11/6/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211622 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: 3 PLAN NO: PARCEL ID:
4635572213
STREET ADDRESS:
242 Shoreline Loop
Mooresville, NC 28117
Please print:
Property Owner: David Brooks/Lori Mehen
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Randy Jordan , of Lyfe Marine, Inc.
(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):
3313 Old Chapel Hill Rd
Durham, NC 27707
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Authorized Signature
11.05.21
Date
Authorized Signature
Date

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project NameJaddre...... i � County.
Print Signature
Contractor/agent: Randy Jorcarr
Print
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. 115A NCAC
02H .0506 and 15A NCAC 0213.0243(8)1
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 inthe 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. 115A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)1
5tormwater 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 (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): Z�'aved 52e& Date: 11.05.21

Owner/Agent's Signature* Printed Name
[15A NCAC 02H .0502(f)l
'Agent's signature is valid only if an authorization letter from the owner is provided.
La ke
(At Full Pond/Normal Water Level)
Ful
Norma
Sr
Date
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 walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
Page 3 of 3
FORM: SSGP 10-2013

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Owner/Agent's Signature* Printed Name
[15A NCAC 02H .0502(f)l
'Agent's signature is valid only if an authorization letter from the owner is provided.
La ke
(At Full Pond/Normal Water Level)
Ful
Norma
Sr
Date
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 walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
Page 3 of 3
FORM: SSGP 10-2013