20231348 Ver 1_Shoreline Stabilization_20231004

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.
Pre -Filing Meeting Date Request was 9/27/2023
submitted on: *
Owner Information:
....................................................................................
Name: *
Email: *
Phone Number:
Mailing Address: *
MMIT GROUP FUND 2020A
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
302 Windemere Isle Road
Address Line 2
City
Statesville
Postal / Zip Code
28677
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
TAMARA HAGER
LAKE PERMIT LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
US

Mailing Address: *
Street Address
PO BOX 5335
Address Line 2
City
MOORESVILLE
Postal / Zip Code
28117
A signed and dated copy of the Agent Authorization letter:
KEEFER AUTH.pdf
KEEFER AGENT .pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* MMIT GROUP FUND 2020A
State / Province / Region
NC
Country
US
152.42KB
96.46KB
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:
Latitude: * 35.664903
Longitude: *-80.963464
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 *
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.)
4. Location of the property (where work is to be conducted)

Nearest Town: * STATESVILLE
County: * Iredell
Lake/ river/ ocean adjacent to NORMAN/CATAWBA
property:
Subdivisions name or site address: * WINDEMERE ISLAND/ LOT 25
Include phase/lot number
Directions to site:*
FROM MARSHALL STEAM STATION TRAVEL WESTAO MILES HWY 150, TURN RIGHT SHERRILLS FORD RD .80
MILES RIGHT MOLLYS BACKBONE 3.0 MILES, KSLIGHT LEFT ONTO MONBO RD 2.7 MILES, RIGHT LONG ISLAND
RD 1.3 MILES, LEFT OTO KALE RD .90 MILES, LEFT KALE RD 90 FT, RIGHT HUDSON CHAPEL RD 1.3 MILES,
RIGHT PINEVILLE RD 1.7 MILES, RIGHT EAST MONBO RD 2.5 MILES, LEFT HERONWOOD RD .60 MILES,
PROPERTY ON RIGHT IN.70 MILES.
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 .51
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
RIP RAP BARE ERODED AREAS FOR 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.)
345
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.)
460
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)
TREES IMPACTED WILL BE REMOVED ONLY FOR SHORELINE STABILIZATION AND TO CONSTRUCT PIER IN THE
PLOT MAP.
Sketch: KEEFER SKETCH.pdf 110.04KB
KEEFER SURVEY & PLOT MAP .pdf 178.32KB
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):
d $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:

d I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
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.
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');
d 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:* MMIT GROUP FUND 2020A
Signature:
##1T ffMMu fuJD 10.7M
Submittal Date: 9/27/2023

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20231348 Version: *
Select Reviewer: *
Select Reviewing Office
Has payment been received?*
What amount is owed?*
Andrew Pitner:andrew.pitner
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification
$240.00 $570.00
$323.00
$767.00