20220048 Ver 1_Shoreline Stabilization_20220110

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.
Helen Lee
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
1652 Wanzer Drive
Address Line 2
City
Denver
Postal / Zip Code
28037
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Dean Fisher
State / Province / Region
NC
Country
USA
Lake Norman Custom Dock & Pile Driving, Inc
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:* Street Address
PO Box 1439
Address Line 2
City
State / Province / Region
Denver
NC
Postal / Zip Code
Country
28037
USA
A signed and dated copy of the Agent Authorization letter:
Agent form.pdf 64.25KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Lee 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
Upload Map: vicinity map.pdf
Latitude: * 35.456649
413.74KB
Longitude: *-80.959148
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*
plot plan.pdf 124.05KB
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.)
photo2.pdf 23.28MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Denver
County: * Lincoln
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: * 1652 Wanzer Dr Denver, NC 28037 lot number 40
Include phase/lot number

Directions to site: *
Head southeast on NC-16 Business S. Turn left onto Hagers Ferry Rd.
Slight left to stay on Hagers Ferry Rd. Turn left to stay on Hagers Ferry
Rd. Turn right onto Wanzer Dr.. Property 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
Residential, undeveloped, etc.
6. Property Size 0.956
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Grading, clearing and backfill along shoreline. Installation and grading of
approx 6x260ft along shoreline for RipRap refresh with fabric.
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.)
1236 sq ft
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.)
2600 sq ft
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)
manicured lawn
Sketch: Catawba RIP form (2).pdf 607.62KB
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):
0 $240.00 for impacts to lake (below normal water level) of less than 1 acre
0 $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');
0 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:* Dean Fisher
Signature:
9
Submittal Date: 1/6/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220048 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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIMON:
LOTi No. 40 PLAN NO- _ PAf,CEL 1-1); 24
TREET,4bbRESS; 1652 wart r Dr, Denver NC 28037
PIS Ont= Helm Lee
Prc pertyr Owner: -
The urlde75ignedr rcglwed pmpartyr mm'?ffs Of the above noted property, do hereby wtl- i2e
Dean F5het i President Lake Norman Gustom Dock & Pile Driving , inc
(Contractor { Ag mt) pYarne of consu ib ng firm)
to act on my behalf and take all aGtionS rwx�e-�:-yr for the processIrigr i55Uartce and acceptance af
this Ida or oe iica#ion and any and all 5td ridard and special condlbons atta .
Property{ Cwnerrs Address (it difFPxwt than p weEtY abaue);
Tefephow: 704412681.0
We h&eW CffW the above Infarmakn eubmhted in thfiS appl;cad0n iS true and ZOMMke ft] the
best of our knowledge,
Authorized Signature
Authorized Sigr=jre
Rake= S" : 9 - l _ Date_

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CATAWBA RIPARIAN BUFFER NOTIFICATION 1 ORM
Project Namefaddress;
owner: Helen Lee
$hQrelin e/1652 VVEinzer pr Denver, NC 28087 Count,, 1_MMIR
Print Si �
Coritraetor{agent= Dew Fshff -- _
pOnt Sigrraturc
The a pprora€ IS for the I urpoo a+nd design describE?d in your application- Impac[s not indl fated in the
applig%tion is a violation of the burffe r Rule. Site sp2cifie wor>a 511ou1cl be provided in the a ppl ication. [ISA NCAC
-132H ,0546 and ISA NCAC 0215 ,0243(�L))
T rees are not ailed to be remgved From Zo ne I of the Buffer (withi n 30 Ft of the. full pond eIe�,vati-an}, unless
approved. Exce fAionr those trees that a re ri-r-.1y undermi-ned along the i mmed iate shofel.ine ran he removed-
Mirdmul shaping and slopi ng a Ipng the irnmcclsate !�lnoreli ne is aklowOd, (I SA KCAC 02B-0Z43(6)1
Benchi ng, �tradi ng i n the buffer is not al lowed- Exoessive di stLLrha nre of ground ever- [15A NCAC 02 B . R243 (r:>)j
machcLs, impervious patios, impe rlriQLg wig Ikways, etc, are not al lowed in the buffer er unless specifleally approved
by the Division- There are IImitation an size for decks. [15A N1=AC ❑ZB-W4-3(4) and (6)]
Work to be cDnduded from la nd rn ust irFd icat42 an -aoeess and Indicate and+ trees that are to fie remOve.d. The
work corridor should be dj! etj.bed- The approved access 4�gcrl-dor shall be rmt-afed. A39ingr spoil, construction
materia I must € e 005MR the buffer- [I5A NCAC 02» .0502 artd 15A MCAC 02B -0243 (4), (6), [811
-Sti)rmwater carmot be piped Dr channeled for di rest discharge to trre lake. All im nsi-ructrd storffmn-er
discha rgcs m ust b)e at the nature I t:bevation and rflw`harged prior tip -entering th-P buffer dirFcted as di ffuse -ar
sheet flow at rlori-ercive veiocities to the 1pke- [15A NCAC 021� -�043JEJ, (e)J
Acknowledgement of Notificaflun
I, t Ielerr Lee _ , hers: bV stste that 1 bave bleen intor rtiea Of -the CataWua
liiparlan buffer Ru le. Any work conducted ir1 t€-te buffer, not specifically SM�ed in the application 0 nd approved
by the -Divis iorr of vvale r Resources 4 DVWR), is a violation a lid sut�Jeot to en#arcernent. Due diLlgencL- wi:l be
Lid ken Such that the construction will be bui It within substantial compharioe -and i nterrt of the 401 Water
QMali#y Certifica Lion and Bvtfer Rukc . the approved *n(s) and and other su pparti ng
Materi$L5_
Signature (awncr), _ ILZ,d Date: 4
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