20220090 Ver 1_Shoreline Stabilization_20220118

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: *
Michael Korsnick
Email: *
[e-mail]
Phone Number:
[phone]
(xxx)xxx-xxxx
Mailing Address: *
Street Address
3510 Castle Way
Address Line 2
City
Davidsonville
Postal / Zip Code
21035
Is there an agent working on the project?* Yes
No
Project Information [15A NCAC 02H .0502(a) & (b)]
.........................................................................................................................................................................................
Project Name:* Michael Korsnick (Shore Stabilization)
State / Province / Region
MD
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

Property Address Lookup: * Street Address
121 Sunset Ct
Address Line 2
City
Mount Gilead
Postal / Zip Code
27306
Latitude: * 35.293836
State / Province / Region
North Carolina
Country
United States
Longitude: *-80.086748
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*
scan0020.pdf 274.39KB
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.)
scan0022.pdf 567.72KB
4. Location of the property (where work is to be conducted)
Nearest Town: * Mount Gilead
County: * Montgomery
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address:* Tillery Traditions
Include phase/lot number
Directions to site:
Rt 24/27 to Rt 73
From Albemarle turn Right on Rt 73 toward Mt. Gilead
Turn Right On Lillys Bridge Road
Turn Right on Traditions DR
Turn Right on Shagbark CT
Turn Left On Sunset Ct
Turn Left into 121 Sunset CT
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, developed with dwelling on property
Residential, undeveloped, etc.
6. Property Size 1.68
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Add Shore Stabilization; (Rip -Rap) to help prevent continued erosion of
shoreline

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.)
1000
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.)
1250
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)
8-10 dead leaning trees will be impacted, may be less depending condition
of roots, but for initial observation could be 8-10. Land area above
proposed disturbed area has minimal vegetation.
Sketch: scan0023.pdf 368.29KB
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:* Michael Korsnick
Signature:
it
Submittal Date: 1/17/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220090 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