20220340 Ver 1_Shoreline Stabilization_20220303

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.
Tim Berghoff
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
21317 Country Club Drive
Address Line 2
City
Cornelius
Postal / Zip Code
28031-6629
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
...............................................................................................................................................................................
Name: * Janice Estep
Company Affiliation: * CBC Stone & Recycling, LLC
Email: * [e-mail]
Phone Number: * [phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
US

Mailing Address:*
Street Address
638 Oakridge Farm Hwy
Address Line 2
City
Mooresville
Postal / Zip Code
28115
A signed and dated copy of the Agent Authorization letter:
Auth. Form.pdf 680.19KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Berghoff Shoreline
State / Province / Region
NC
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: *
Latitude: * 35.487968
Street Address
20939 Cinnamon Tree Ln
Address Line 2
City
Cornelius
Postal / Zip Code
28031
State / Province / Region
NC
Country
US
Longitude: *-80.892492
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*
Site Plan.pdf 896.76KB
Buffer Form.pdf 1.12MB
Please use the diagram at the link below:
https:Hedocs.deq.nc.gov/WaterResources/O/edoc/616616/Shoreline%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.)
Shoreline Pics.pdf 28.7MB
4. Location of the property (where work is to be conducted)
Nearest Town: * Cornelius

County: * Mecklenburg
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: * Lot 4 Keel Bay Phase 1
Include phase/lot number

Directions to site: *
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
15s(197ft)
Turn right onto E Center Ave
2 min (0.5 mi)
Continue on S Church St to S Main St
2 min (0.6 mi)
Turn left onto S Church St
0.5 mi
Turn right onto College St
0.1 mi
Continue on S Main St. Take NC-115 S, Langtree Rd and I-77 S/US-21 S
to Bethel Church Rd in Cornelius
14 min (8.4 mi)
Turn left onto S Main St
1.2 mi
Continue onto NC-115 S
2.1 mi
Turn right onto Langtree Rd
1.1 mi
Use the left 2 lanes to turn left to merge onto I-77 S/US-21 S
3.1 mi
Take exit 28 for US-21 S toward Catawba Ave/Lake Norman/Cornelius
0.2 mi
Keep right at the fork, follow signs for Lake Norman and merge onto W
Catawba Ave
0.8 mi
Follow Bethel Church Rd and Norman Colony Rd to Colony Point Ln
2 min (0.6 mi)
Turn right onto Bethel Church Rd
0.3 mi
Turn right onto Norman Colony Rd
0.4 mi
Turn left onto Colony Point Ln
Destination will be on the right
105 ft
20939 Cinnamon Tree Ln
Cornelius, NC 28031
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 new construction
Residential, undeveloped, etc.
6. Property Size 1.054 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Install a VA Fieldstone wall with cap and install TN Crab Orchard steps
for new shoreline stabilization
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.)
Y below (270 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' above (90 sf) 10'
x 50' access
corridor (500 sf of
temp. impact)
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)
Grass buffer, no trees removed, minimal disturbance to buffer. Buffer will
be restored to original condition.
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");
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:* Janice Estep

Signature:
Submittal Date: 3/3/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220340 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 NO. --A. PLAN NO.
STREET ADDRESS: )0'1 -3 q c,,,, ,
Please print;
Property Owner:
Property Owner: --
PARCEL ID:
The undersigned, registered Property owners of the above noted property, do hereby authorize
Of
(Contractor / Agent)
(Name of �consul�tingfirm��l
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 than Property above):
e bv �03
Telephone: 6 L/
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date:
-41
Authorjz—signature
A I
Date: 1 ram' I V)-

LINE TABLE
16.896 AC.+— TOTAL PHASE 1
12,812 AC.+— TOTAL THIS MAP
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Please approximately sketch the following information on this plan, length of shoreline
(provide dimens/OOSforeach item, such Ds2Oftx2OOfH*:
l. All proposed vegetation clearing
Z. Location of rip rap or fill to be placed above the Full Pond/ 0Vrnoa| Water Level elevation
B. Location Ofrip rap O[fill tObgplaced below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such asbuildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location ufconstruction access corridors
FORM: SSGP1O'2O13
Page 3 of 3

Project Name/address:
°County. MeJdtlk 4
Owner-, rim
Print
Contractor/agent:
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(8)]
Trees are not allowed to be removed from Zone I of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those treesthat 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, 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 028.0243(4) and (6)]
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. USA NCAC 02H.0502 and ISA NCAC 0213.0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All 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 of Notification
hereby state that I have been informed of the Catawba
Riparian Buffer Rule. A4 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" .

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