20231469 Ver 1_Shoreline Stabilization_20231031

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 10/26/2023
submitted on: *
Owner Information:
....................................................................................
Name: *
Email: *
Phone Number:
Mailing Address: *
Daniel & Kimberly Cook
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
22120 Country Club Circle
Address Line 2
City
Cornelius
Postal / Zip Code
28031-6620
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:
Agent Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * Cook Shoreline
State / Province / Region
NC
Country
United States
624.31KB
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
22120 Country Club Circle
Address Line 2
City State / Province / Region
Cornelius NC
Postal / Zip Code Country
28031-6620 US
Latitude: * 35.501272 Longitude: *-80.883847
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: * Cornelius
County: * Mecklenburg
Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address: * Lot 29 & tract Country Club Shores
Include phase/lot number
Directions to site:*
610 E Center Ave
Mooresville, NC 28115
Head south on Evergreen St toward E Center Ave
11 sec (197 ft)
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 to Torrence Chapel Rd in Cornelius
13 min (7.8 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 1-77 S/US-21 S
2.9 mi
Use the right lane to keep right at the fork and continue on I-77 S
0.2 mi
Take exit 28 for US-21 S toward Catawba Ave/Lake Norman/Comelius
0.1 mi
T TeP the r;oht la„P t� IrPP„ r;oht at the f rlr f ll�.x, �;�.,,� f r 1 .1— N-- —I W C.t-1— A—

0.1 mi
Continue on Torrence Chapel Rd. Drive to Country Club Cir
4 min (1.7 mi)
Turn right onto Torrence Chapel Rd
1.5 mi
Turn right onto Country Club Dr
0.2 mi
Turn right onto Country Club Cir
Destination will be on the right
453 ft
22120 Country Club Cir
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
Residential, undeveloped, etc.
6. Property Size 0.62 acres
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Remove existing damaged block wall and brick steps and replace with new Allen block wall and TN Crab Orchard steps.
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 (414 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 (138 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, not trees removed, minimal disturbance to buffer. Access corridor will be restored to original condition once project
is completed.
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 $323.00 for impacts to lake (below normal water level) of less than 1 acre

o $767.00 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:* Janice Estep
Signature:
Submittal Date: 10/26/2023

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20231469 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