20240473 Ver 1_Shoreline Stabilization_20240327

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.
Jerry Brett Mullis
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
5311 Love Mill Road
Address Line 2
City
Monroe
Postal / Zip Code
28110-7565
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: * Alex Ricketts
Company Affiliation:
Email: *
Phone Number:*
Anchored Design
alextickettsl [e-mail]
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
Us

Mailing Address: *
Street Address
49470 Wood Land Drive
Address Line 2
City
Norwood
Postal / Zip Code
28128-6440
A signed and dated copy of the Agent Authorization letter:
Mullis Signed Agent Auth Form.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Mullis Shoreline
State / Province / Region
NC
Country
US
649.58KB
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
5311 Love Mill Road
Address Line 2
City
Monroe
Postal / Zip Code
28110-7565
Latitude: * 35.131126
State / Province / Region
NC
Country
US
Longitude: *-80.453534
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: * Albermarle
County: * Stanly
Lake/ river/ ocean adjacent to Lake Tillery
property:
Subdivisions name or site address: * 49268 Swift Water Road, Albermarle, NC, 28001
Include phase/lot number
Directions to site:*
Off of 24/27 turn onto Lake Tillery Road, follow back to Swift Water Road, Property will be on your right.
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 .242
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Natural Shoreline Showing Erosion. Re-stablize with rock.
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.)
135
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.)
135
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)
Two Trees and Grass.
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
d $767.00 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
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:* Alex Ricketts
Signature:
Submittal Date: 3/22/2024

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20240473 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