20211742 Ver 1_Shoreline Stabilization_20211202

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 * [e-mail]
Please provide an email address for payment and requests for more information here.
Owner Information:
Name: * Jonathan Travis
Email: * [e-mail]
Phone Number: * [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
P.O. Box 1200
Address Line 2
City
State / Province / Region
Troutman
NC
Postal / Zip Code
Country
28166
NC
Is there an agent working on the project?* - Yes
O No
Agent/Consultant Information
...................................................................................................
Name: *
Company Affiliation:
Email: *
Phone Number:*
Janice Estep
CBC Stone & Recycling, LLC
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:*
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 614.64KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Travis 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
228 Penicillin Point
Address Line 2
City
Troutman
Postal / Zip Code
28166
Latitude: * 35.631579
State / Province / Region
NC
Country
US
Longitude: *-80.933583
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 1.06MB
Buffer Form.pdf 1.08MB
Please use the diagram at the link below:
https:Hedocs.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 11.09MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Troutman

County: * Iredell
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: * Lot # Pt. 32 Lakeview Acres
Include phase/lot number
Directions to site:
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
9s(197ft)
Take NC-115 N, Cornelius Rd, Perth Rd and State Park Rd to Morrison
Farm Rd
21 min (11.9 mi)
Turn right onto E Center Ave
0.5 mi
Turn right onto N Church St
0.2 mi
Turn left onto E Iredell Ave
0.1 mi
Turn right onto NC-115 N/N Broad St
Continue to follow NC-115 N
2.1 mi
Turn left onto Connector Rd
0.8 mi
Continue onto Cornelius Rd
2.4 mi
Turn right onto Judas Rd
1.2 mi
Turn right onto Perth Rd
3.0 mi
Turn left onto State Park Rd
1.4 mi
Continue on Morrison Farm Rd. Drive to Penicillin Point
5 min (2.9 mi)
Turn left onto Morrison Farm Rd
2.4 mi
Turn right onto Penicillin Point
0.5 mi
228 Penicillin Point
Troutman, NC 28166
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 0.79 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Demo existing block boat house. Structure is unsound. In area where boat
house is to be removed, shape and slope shoreline, install matting and
install class "B" rip rap to stabilize. From dock to point of property and
around to side of property without dock, install a layer of class "B" rip rap
to freshen existing stabilization. Install TN Crab Orchard steps in area
where boat house will be removed.
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.)
6' below (2,892 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.)
I' above (482 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:*
(number of trees, for instance)
Grass buffer, no trees removed, minimal disturbance to buffer
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:
Crr G�Q'F��Y Cy.�ww�Fmr.arni
Submittal Date: 11/30/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211742 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

PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID:
STREET ADDRESS:
f-
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize (Contractor / Agent) (Name of consulting fih) -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 prope* above):
-20
Telephone: 3&
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
A6thorized Signature Authorized Signature
Date: — /0// 7 /2 ov p Date.

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Full Pond/
Norma. Water Level.
Shoreline
Lake
(At Full Pond/Normal Water Level)
60CA+ Lvt)e
V 5-e�
I, "Ove x46A,
ie
60u5 e. +c) remC Q Ed
No + rues remo u eel
1f', r,'-'rnC l a, 5+v r bDance-
��
}c� he done cn c�r�,
Whec� bc�-} �Uv�e IS
r2mov ed,
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 10 ft x 100 ftJ *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
I 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
FORM: SSGP 10-2013
Page 3 of 3

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: c ry X Povi, c. d 1;A Pt Ti 'g Al
f -- C 1 6,6 County.r�r' /
Owner:
Print
Contractor/agent: _
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. [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 028.0243 (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 NoVfrcotion
I, 'Ti3 �+ f hri✓+ '["r s� , ic 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: / U/ l 7 /3 �J %

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