20240403 Ver 1_Shoreline Stabilization_20240312

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.
TOM & BONNIE KANIA
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
5425 CHEGALL CROSSING WAY
Address Line 2
City
MOUNT HOLLY
Postal / Zip Code
28120
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:
KANIA AGENT.pdf
SKETCH AUTH.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * KANIA
State / Province / Region
NC
Country
US
96.12KB
163.87KB
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: * 35.361999
Longitude: *-80.931437
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: *
County: *
Lake/ river/ ocean adjacent to
property:
MOUNT HOLLY
Gaston
MT ISLAND LAKE / CATAWBA
Subdivisions name or site address:* IMAGERY ON MOUNTAIN ISLAND / LOT 290
Include phase/lot number
Directions to site:*
RIVERBEND BOAT RAMP RIGHT .20 MILES HORSESHOE BEND BEACH RD, SLIGHT LEFT IMAGERY BLVD 1.8
MILES, 500 FT ROUNDABOUT FIRST EXIT DALI BLVD, RIGHT CHEGALL CROSSING WAY .20 MILES, LEFT
CHEGALL CROSSING WAY .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 .81
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
SHORELINE STABILIZATION RIP RAP 200'
GRAVEL CART PATH TO PIER 4 X 1000' LENGTH
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.)
400
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.)
800
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)
800' RIP RAP
MINMAL TREES REMOVED FOR SHORELINE STABILIZATION AND CONSTRUCT PIER / DOCK
DEAD TREES/ DEAD STUMBS FOR SHORELINE SEE PHOTO
Sketch: SKETCH SHORELINE .pdf 107.48KB
SKETCH CART PATH.pdf 98.41KB
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 $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:* TOM AND BONNIE KANIA
Signature:
TOM AM gOAW ZWA
Submittal Date: 3/6/2024

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20240403 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