20220032 Ver 1_Shoreline Stabilization_20220105

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.
David Shuman
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
8474 Catawba Cove Dr
Address Line 2
City
Belmont
Postal / Zip Code
28052
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
...................................................................................................
Name: *
Company Affiliation:
Email: *
Phone Number:*
Kim Broome
Dock Masters Marine
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
Gaston

Mailing Address:*
Street Address
5850 Charlotte Hwy
Address Line 2
City
Clover
Postal / Zip Code
29710
A signed and dated copy of the Agent Authorization letter:
shumanagentlet.pdf 264.44KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Shuman Shoreline
State / Province / Region
SC
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
Upload Map: shumanmap.pdf
Latitude: * 35.161480
225.26KB
Longitude: *-81.069427
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*
shumanplat.pdf 363.09KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/ShoreIine%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.)
Shumanpicshoreline.pdf 532.35KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Belmont
County: * Gaston
Lake/ river/ ocean adjacent to Lake Wylie
property:
Subdivisions name or site address: * 8466 Catawba Cove Dr, Belmont, NC 28012
Include phase/lot number

Directions to site: *
Hwy 49 to Pole Branch Rd turn R onto Catawba Cove Dr follow Catawba
Cove Dr end at 8466 Catawba Cove Dr
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 1.045 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Place rip rap along approx. 252' of shoreline to aid in erosion control
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.)
1008
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.)
756
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)
Only trees 2" or less, undermined or dead will be removed
Sketch: shumanplan view.pdf 399.71KB
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:* Kim Broome

Signature:
Submittal Date: 1/3/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220032 Version: *
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Doug Perez:eads\djperez
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 Nc_
Street Address
Plan No. Parcel ID:
Property Owner:�CIv'+<\ �`_`�r•� �� . -. �
The undersigned, registered property owner of the above noted property, do
hereby authorize
0�f
Contractor/ agent Business Name
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 from above):
Telephone:
We hereby certify the above information submitted in this application is true
and accurate to the best of our knowledge.
Authorized Signature
Date: I - � - " 02 /
Authorized. Signature
Date: .....r::

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