20220433 Ver 1_Shoreline Stabilization_20220317

Shoreline Stabilization Application Form
NORTH CAROLINA
EnWnnmentufQu&lry
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 *
Owner Information:
Name:*
Email:*
Phone Number:
Mailing Address: *
Kim@dockmastersonline. com
Please provide an email address for payment and requests for more information here.
Don Chudanov
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
2484 N W Everglades Blvd
Address Line 2
City State / Province / Region
Clover SC
Postal / Zip Code Country
29710 US
Is there an agent working on the project? * ® Yes
No
Agent/Consultant Information
Name: *
Company Affiliation: *
Email:*
Phone Number:*
Kim Broome
Dock Masters Marine
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address: *
Street Address
5850 Charlotte Hwy
Address Line 2
City State / Province / Region
Clover SC
Postal / Zip Code Country
29710 United States
A signed and dated copy of the Agent Authorization letter: *
Chudanovagent.pdf 264.46KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Chudanov 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: chudanovmap3.pdf 273.83KB
Latitude:* 35.171070
Longitude: *-81.047220
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*
chudanovsurvey.pdf
chudanovdraw.pdf
Please use the diagram at the link below:
335.04KB
476.25KB
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.)
chudanovpics.pdf 894.22KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Belmont
County: * Gaston
Lake/ river/ ocean adjacent to Lake Wylie
property:
Subdivisions name or site address: *
5129 Woodland Bay Dr Lot 46
Include phase/lot number

Directions to site: *
right onto Charlotte Hwy right onto Pole Branch Rd at the roundabout
take the second exit onto S new Hope Rd turn right onto Woodland Bay
Dr. Destination will be on your left 5129 Woodland Bay Dr
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: *
Future Residential
Residential, undeveloped, etc.
6. Property Size .809
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Place rip rap along approx 140' to aid in erosion control.
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.)
560'
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.)
420'
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)
Only undermined, dead or 2" or less trees will be removed
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):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
a 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.
a 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");
a 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 I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
a I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Kim Broome

Signature:
Submittal Date: 3/16/2022

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20220433 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?*
C• $240.00
C $570.00

A a AUTHORIZATION FORM
Property legal description
Lot No. '''kj, Plan No. Pare 1 r %af
Street A. h$
. 4i qL
Own, 3 No
propertyThe undersigned,registered owner of the above noted property,do
1:11
Contractor/agent Business Name
To act on my behalf and take all actions necessary for the pig,
issuance and acceptance of this permit or certification and any and all
standard and special conditions attache&
Property owner's address(if different from above):
Telephone: - \N
We hereby certify the above information submitted in this application is true
and awe to the lest of OUT knowledge.
e,Zrue-- C"tioro-- 2-1:DC)
Authorized Sigma A Signature

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DON AND JEAN CHUDANOV
NCINITY MAP
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I-. = _FIELD WORK_ _•w,sK _ FIE! :) HOOK #__--_-
_J21`}T:\Wo;Nnc,a Her rS ld

Full Pond/ Normal Water Level
WI:WWI
,.
Shoreline
Plan View
La ke
(At Full Pond/ Norma! Water level}
AO 40 Al r� uwa i marl ierOdavaie.rjo
450
ao
I40 r
..sIPA P,AIPsas+4.
Full Pond/ Normal Water Level
""t re ne s
2ft.x150ft.
additional clearing
' if necessary
Plan View
Lake
(At Full Pond/ Normal Water level)
Existing Dock
30ftx7ft
rub. ,•tlIrlwl�uN+rrF 41101110/0000)1114111.1,11 Nina*
r�.�a�
l� e'
rwwi,wwtitt rwR Riprap
:71 tile CI Ci It
p* g
a ft 150 ft
Below NM pond/ NWL
r SEW
NM
159Ft
Above fall pond/ NWL
FORM: SSGP 09-2020 Page 4 of 6

CO
La ke
(At Full Pond/ Normal Water Level)
Side View
FORM: SSGP 09-2020 Page 5 of 6

Untitled Map
Write a description for your map.
egacy Ministries Church o•f Charlotte
_any Overtake by Tri Pointe Homes
Allderm
Legend
‘77' 5129 Woodland Bay Dr
9 Allderm
9 Daniel Stowe Botanical Garden
9 Legacy Ministries Church of Charlotte
9 McLean
A
N
1000 ft