20211811 Ver 1_Shoreline Stabilization_20211214

Submission Form
I. Applicant Information [I5A 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.
James Lee
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
2810 Phillippe Drive
Address Line 2
City
Safety Harbor
Postal / Zip Code
34695
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Donna P. Hrko
State / Province / Region
FL
Country
US
Lancaster's Custom Dock and Lift Systems, Inc.
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:* Street Address
1156 Perth Road
Address Line 2
City
State / Province / Region
Troutman
NC
Postal / Zip Code
Country
28166-8640
US
A signed and dated copy of the Agent Authorization letter:
Lee Signed Agent Authorization Form.pdf 146.47KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Lee Boat Slip Access Dredge
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
174 Winding Shore Road
Address Line 2
City
State / Province / Region
Troutman
NC
Postal / Zip Code
Country
28166-9786
US
Latitude: * 35.657869 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 *
Lee Site Plan Survey Property Data and Duke
6.87MB
Forms.pdf
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.)*
Lee Photographs.pdf 476.99KB
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: * Crescent Land + Timber Corp. Lot 921 174 Winding Shore Rd. Troutman,
NC 28166
Include phase/lot number
Directions to site: *
From 1-77 NB, Exit 36, Left onto River Highway (NC-150 WB), Right
onto Perth Road, Left onto Neil Farm Road, Right onto Winding Shore
Road. Property is immediately on the left. Gravel driveway at large
detached garage is easiest lake access.
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 2.71 Acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Dredge area adjacent to boat slip and lakeward for boat slip access.
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.)
4,190 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.)
500 sf construction
corridor
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)
None
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:* Donna P. Hrko
Signature:
Submittal Date: 12/14/2021

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20211811 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