20220339 Ver 1_Shoreline Stabilization_20220303

•
Shoreline Stabilization Application Form `" 'a,
NORTH CAROLINA
EnWrortmental Quaiity
15A NCAC 02H.0500—Water Quality Certification,Shoreline Stabilization
FORM:SSGP 10-2013
DRAFT-NOT FOR USE AT THIS TIME
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:* Doris Cavallone
Email:* [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
89 Jordan Road
Address Line 2
City State/Province/Region
Rockaway NJ
Postal/Zip Code Country
07866 USA
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name:* Donna P Hrko
Company Affiliation:* Lancaster's Custom Dock and Lift Systems,Inc.
Email:* [e-mail]
Phone Number:* [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:*
Cavallone Signed Agent Authorization
147.11KB
Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Cavallone Shoreline Refresh
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
146 Eagle Chase Lane
Address Line 2
City State/Province/Region
Troutman NC
Postal/Zip Code Country
28166-8802 US
Latitude:* 35.658594 Longitude:* -80.934619
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*
Cavallone Detailed Site Plan and Misc..pdf 1.23MB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%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.)
Cavallone Pic#1.pdf 473.62KB
Cavallone Shoreline Pic#2.pdf 3.8MB
Cavallone Shoreline Pic#4.pdf 245.94KB
Cavallone Shoreline Pic#5.pdf 310.06KB
Cavallone Shoreline Pic#6.pdf 3.96MB
Cavallone Shoreline Pic#7.pdf 335.47KB
Cavallone Shoreline Pic#3.pdf 3.54MB
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:* Wildlife Bay,Phase 1 Lots 60&61,146 Eagle Chase Lane Troutman,Nc
28166
Include phase/lot number
Directions to site:*
From I-77 NB to Exit 42 Troutman,Left onto US-21 NB into Troutman,
Left onto Wagner Street/Perth Road,Right onto State park Road,Left onto
Wildlife Haven Road,Right onto Sierra Woods Drive,Left onto Deer Run
Drive,Right onto Eagle Chase Lane.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 1.845 Acres
Acres
7. Describe proposed work(include discussion as to how hardening of shoreline has been avoided,or
why it is necessary):
Shoreline refresh with Geotech Fabric,Class A and Class B rip rap for
stabilization and erosion control.
8. How will the work be done?* From Land
C� 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.)
1,824 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.)
1,108 sf incl.
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):
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");
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");
o 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:* Donna P.Hrko
Signature:
WiEe
Submittal Date: 3/3/2022

Initial Review
Is this accepted into the review process?* • Yes No
Project Number:* 20220339 Version:* 1
Select Reviewer:* Doug Perez:eads\djperez
Select Reviewing Office: Mooresville Regional Office-[phone]
Has payment been received?* No Payment Needed
c_ Fee Received
C• Need Fee-send electronic notification
What amount is owed?* '• $240.00
$570.00

AGENT AUTHORIZATION FORM
PROPERTY LEGAL.DESCRIPTION:
LOT NO: 60-61 _ PLAN NO: _ PARCEL ID: 4720-50-3179
S l REET ADDRESS:
146 Eagle Chase Lane
Troutman, NC 28166
Please print:
Property Owner: Doris Cavailone
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko - , of Lancaster Custom Dock and Lift Systems, Inc.
(Contractor/Agent) (Name of consulting firm)
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 Owners Address(if different than property above):
89 Jordan Road
Rockaway, N3 07866
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
hest of our knowledge.
Authorized Signature Authorized Signature
1-6-22
Date Date

Lake
(At Full Pond/Normal Water Level)
,
Full Pond/ Normal Water Level "�'et-'4,=-_-►.4-" w"- - _w+,�0.
. .� x(o L
Shoreline �rt►�a►r+� alli��1"rr�'�� � .r�s„17 r- Lops
ral
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Plan View
Lake
IX Full Pond/Norml Water Lces0 Existing Dock
30ttx7Ft
�`�.r,� ra r,�.� 3"x 150 Ft
r -rirr�Y.r"� Below full pond/NW/
Full Pond/Normal Water Level !^^5 rev ti,_=Y. __,
�!•oreline — RarRsimow f 4kx150h
• `r eg a R€prdp "10 Above fall pond/r WL
2ft-x15�0ft. eFor 004 10000
additional elearlig
•If necessary
E AM P E
FORM:SSG 09-2020 Page 4 of 6
Plan View

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W
Lake ',
(At Full Pond/Normal Water Level) IL;
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Side View 0
u_
FORM:SSGP 09-2020 Page 5 of 6

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3/3/22, 10:49 AM Property Data
I redel I County
Property Data
Parcel Number:4720503179.000
Inquiry Date: 3/3/2022
Disclaimer:While every effort is made to keep information provided over the Internet accurate and up-to-date,the County does not certify
the authenticity or accuracy of such information.No warranties,express or implied,are provided for the records and/or mapping data
herein,or for their use or interpretation by the User.
Property Map
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Owner/Property Info
Tax Account Number:80057702
Old Parcel Number:
Owner Name:CAVALLONE 3OHN+DORIS A
Mailing Address:89 JORDAN RD ROCKAWAY NJ 07866
Property Location: EAGLE CHASE LN
Lot Number: 60+61
Legal Description:WILDLIFE BAY PI REV PB31-83-87
Municipal Information
Township Code: I5
City Code:Null
Neighborhood Code: 15041
Value Information -Current Year Prolgdy Record Card(PRC)
Building Value:80907o
Other Building Features: 115920
Land Value: 385000
Tax Assessed Value: 1309990
Deferred:Null
Land Information -Register of Deeds Online Search
web3.mobi1e311.corn/lredellReportlreport.aspx?PI N=4720503179.000 1/2

3/3/22, 10:49 AM Property Data
Date Recorded Document Type Deed Book Deed Page Plat Book&Page Land Area Land Type Zoning
20181010 WD 2583 9 31-83 1.91 AC R20
Tax Information
Exemption Tax Code 1 Tax Code 2 Tax Code 3 Tax Code 4 Tax Code 5
Null C ADVLTAX Null FRO5ADVLTA)f Null Null
6.Lrr;4,. -70ning Contact Info.
Iredell County 704,878.3118
Harmony 704.878.3118
Love Valley 704.878.3118
City of Statesville 704.878.3575
Town of Troutman 704.528.7600
Town of Mooresville 704.662.7040
Village of Davidson 704,892.7591
web3.mobile311.com/lredellReport/report.aspx?PIN=4720503179.000 2/2

3/3/22,9:55 AM I ConnectGlS Feature Report
eCO VNEC GIS ' f Iredell
WE13 ii05TING `tF.17ELL Printed March 03,2022
Iredell County See Below for Disclaimer
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he maps prepared for this website are generated from recorded deeds,plats,and other public records.Users of these maps are hereby notified that the information
.rovided herein should be verified.Iredell County assumes no legal responsibilities for any of the information contained on this site.Users are advised that the use of
=ny of this information is at their own risk.All maps on this site were prepared using a 1000a€'"Grid based upon the North Carolina State Plane Coordinate System from
he 1983 North American Datum.The delinquent real property tax overlay is updated monthly.The information presented is not intended to be used or relied upon as
.fficial notice of tax liens.For additional information re.ardin.delinquent taxes,contact the Iredell Coun Tax Collectors Office.
https://iredell.connectgis.com/DownloadFile.ashx?i=_ags_mapfe37e6ef3ab84cbfb34192ab5dc76832x.htm&t=print 1l1

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address:Chial1one. Si lord;r e1- _ ii(c, .1 11.. County: f ri C/e,11
�`rr
;-
o u gW
Dwner: Mny1 5 Uck1 nyle, .[l
Print Sign
Contractor/agent: `_ , C + i I yica55-1-e v--
Print Signature
The approval is for the purpose and design described in your application, Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A
NCAC 02H .0506 and 15A NCAC 02B .0243($)j
Trees are not allowed to be removed from Zone 1 of the Buffer(within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be
removed. Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)]
Benching and grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B
.0243 (6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically
approved by the Division. There are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)j
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described.The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. Ail constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non-erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement a Notification
1, l -)C)r1s Nail on e , hereby state that I have been informed of the Catawba
Riparian Buffer Rule. Any work conducted in the buffer, not specifically stated in the application and approved
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules,the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner): Date: /- -/L

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