20211795 Ver 1_Shoreline Stabilization_20211209

Shoreline Stabilization Application Form
15A NCAC 02H.0500—Water Quality Certification,Shoreline Stabilization
FORM:SSGP 10-2013
DRAFT-NOT FOR USE AT THIS TIME
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:* David Novotny
Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
1232 Waterwyck Trail
Address Line 2
City State/Province/Region
Dayton OH
Postal/Zip Code Country
45458-9622 US
Is there an agent working on the project?* * Yes
J No
Agent/Consultant Information
Name:* Janice Estep
Company Affiliation:* CBC Stone&Recycling,LLC
Email:* [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx

Mailing Address:* Street Address
638 Oakridge Farm Hwy
Address Line 2
City State/Province/Region
Mooresville NC
Postal/Zip Code Country
28115 United States
A signed and dated copy of the Agent Authorization letter:*
Auth.Form.pdf 575.32KB
Link to: Sample Agent Authorization Form
Project Information[15A NCAC 02H.0502(a)&(b)]
Project Name:* Novotny 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.*
Upload File
Look up address
Property Address Lookup:* Street Address
8474 Monbo Road
Address Line 2
City State/Province/Region
Catawba NC
Postal/Zip Code Country
28609 US
Latitude:* 35.667392 Longitude:* -80.970679
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 999.37KB
Buffer Form.pdf 1.01MB
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 Pics.pdf 12MB
4. Location of the property(where work is to be conducted)
Nearest Town:* Catawba

County:* Catawba
Lake/river/ocean adjacent to Norman
property:
Subdivisions name or site address:* Lot 2 Monbo Pointe
Include phase/lot number
Directions to site:*
610 E Center Ave
Mooresville,NC 28115
Follow E Center Ave and E McLelland Ave to NC-150 W/E Plaza Dr
6 min(1.7 mi)
Head south on Evergreen St toward E Center Ave
197 ft
Turn right onto E Center Ave
0.5 mi
Turn left onto S Church St
397 ft
Turn right onto E McLelland Ave
1.1 mi
Use any lane to turn left onto NC-150 W/E Plaza Dr
Continue to follow NC-150 W
Pass by Zaxby's Chicken Fingers&Buffalo Wings(on the right in 1.3 mi)
16 min(9.0 mi)
Continue on Sherrills Ford Rd.Take Mollys Backbone Rd to Monbo Rd in
Lake Norman of Catawba
11 min(6.6 mi)
Turn right onto Sherrills Ford Rd
3.0 mi
Turn right onto Mollys Backbone Rd
2.7 mi
Turn right onto Monbo Rd
Destination will be on the left
0.9 mi
8474 Monbo Rd
Catawba,NC 28609
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:*
Undeveloped Lot
Residential,undeveloped,etc.
6. Property Size .580 acres
Acres
7. Describe proposed work(include discussion as to how hardening of shoreline has been avoided,or
why it is necessary):
Remove and haul off shoreline debris.Shape and slope bank,install
matting and install Class"B"rip rap for new shoreline 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.)
4'below(516 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(129 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):
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:
a I,the project proponent, hereby certifies that all information contained herein is true,accurate,and complete to the best
of my knowledge and belief
a 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.
a 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");
a 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 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:* Janice Estep
Signature:
cAtragcLsr r Oralief97SKrkay
Submittal Date: 12/8/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211795 Version:* 1
Select Reviewer:* Alan Johnson:eads\adjohnsonl
Select Reviewing Office: Mooresville Regional Office-[phone]
Has payment been received?* No Payment Needed
Fee Received
• Need Fee-send electronic notification
What amount is owed?* • $240.00
$570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIP I ION:
LOT NO. Lc:'- a PLAN NO. PARCEL ID:
STREET ADDRESS: 8-1`L14 l a loaf.T.
l .-1A-0 ALA as Looq
Please print:
Property Owner: td �o o-t
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
010tce r5-k_e1> , of 0.„3C SA-one n
(Contractor I Agent) 1 (Name of consulting°fir ) J �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):
a,3a LLIA-4-erLu9 .k I r , t 4on O - 'ko 45458,
Telephone: [phone] 0138
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: //' '2/ Date:

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Catawba county Geospatial Real Estate Search
MAKING. LIVING. serTER. Information Services
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Parcel: 471003437601, 8474 MONBO RD CATAWBA, 28609
Owners: NOVOTNY DAVID, SIEWE MARY
Owner Address: 1232 WATERWYCK TR
Values - Building(s): $0, Land: $134,800, Total: $134,800
This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
12/02/2021

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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 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:8 LI 7t4 Mon)ao 121d. e.et.kcwkxt ) oG County: 00,4-0,I Aoa
Owner: /iF,�� ,cr�:'v rr•r �____ '` r
Print Signature
Contractor/agent: C.EC.. cone E jecJ4CI;r1g 1
Eth
Print ( n_ture
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 028.0243(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 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. J
Signature(owner): ` L G?zLL, Date• /7 -i(i 2O j

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