20240445 Ver 1_Shoreline Stabilization_20240320

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.
JUSTIN BUSBY
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
17914 John Connor Road
Address Line 2
City
Cornelius
Postal / Zip Code
28031-7661
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * TAMARA HAGER
State / Province / Region
NC
Country
US
Company Affiliation: * LAKE PERMIT LLC/ RENEGAR CONSTRUCTION
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx

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:
BUSBY AUTH.pdf
BUSBY AGENT.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * BUSBY
State / Province / Region
NC
Country
US
149.05KB
93.06Y-B
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: * 35.457796
Longitude: *-80.923770
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/CATAWBA
property:
Subdivisions name or site address: * THE PENINSULA HERON POINTE, LOT 5
Include phase/lot number
Directions to site:*
FROM COWANS FORD DAM HWY 73 EAST 5.2 MILES, LEFT CATAWBA AVE WEST 2.4 MILES, LEFT JETTON RD 2.0
MILES, LEFT JOHN CONNOR RD .90 MILES, PROPERTY ON LEFT.
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 .406
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
RIP RAP SHORELINE FOR STABILIZATION
AND
REMOVE TWO TREES IN THE 30' BUFFER TO CONSTRUCT SHORELINE AT THE 760 LINE AND REPLACE THE TWO
TREES WITH LIVE TREES.
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.)
132
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.)
198
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)
REMOVE TWO TREES IN PHOTOS IN THE 760 AND REPLACE THEM WITH TWO LIVE TREES.
THE TREES IN THE 760 WILL DIE DUE TO PLACEMENT IN THE SHORELINE FOR RIP RAP AND STABILIZATION.
THE TREES WILL BE REPLACED WITH TWO LIVE TREES.
Sketch: BUSBY SKETCH.pdf 103.65KB
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.

d 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
d 1 intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* JUSTIN BUSBY
Signature:
Jon/ Ovy
Submittal Date: 3/15/2024

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