20161085 Ver 2_Shoreline Stabilization_20220112

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 Sisko
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
112 Forestdale Loop
Address Line 2
City
Lincolmon
Postal / Zip Code
28092
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
...................................................................................................
Name: *
Company Affiliation:
Email: *
Phone Number:*
Saundra B Mosteller
State / Province / Region
North Carolina
Country
United States
Dale & Beth's Lake Use Permit Service
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address:*
Street Address
988 Clear Creek Circle
Address Line 2
City
Lincolnton
Postal / Zip Code
28092
A signed and dated copy of the Agent Authorization letter:
agent form.pdf 539.49KB
catawba buffer pictures.pdf 4.72MB
duke application.pdf 15.05MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Sisko
State / Province / Region
North Carolina
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: vicinity.pdf
long Lat.pdf
directions.pdf
Latitude: * 35.508610
51.45KB
46.09KB
96.02KB
Longitude: *-80.945890
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*
excavation picture drawing plat deed.pdf 5.11 MB
Spoil form pictures plat deed vicinity.pdf 9.91MB
Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/O/edoc/616616/Shorel i ne%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.)
catawba buffer pictures.pdf 4.72MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Mooresville
County: * Iredell

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: * 123 Estes Park Drive Lot 384
Include phase/lot number
Directions to site: *
from 526 S Church St Charlotte NC, head SW on S Church toward W
Stonewall St, turn right to merge onto I0277 S, take exit 1C to merge onto
I-77 N/US 21 N toward Statesville continue to follow I-77 N, take exit 35
for Brawley School Rd toward Charlotte Highway
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 with dock
Residential, undeveloped, etc.
6. Property Size 0.68
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
dredge for boat 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.)
200
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.)
250
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)
no tree removal, grass fescue
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:
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');

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');
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:* Beth Mosteller
Signature:
. • KWM
Submittal Date: 1/11/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20161085 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