20200896 Ver 1_Shoreline Stabilization_20200710

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/8/2020 9:25:18 AM (Submittal)
Approve by Montalvo, Sheri A 7/10/2020 10:19:42 AM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 7/8/2020 9:25 AM

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:*
Is there an agent working on the
project?*
Agent/Consultant Information
.................................................................................................................
Name:
Company Affiliation:
Email:*
Phone Number:*
[e-mail]
Rease provide an email address for payment and requests for more information here.
David Wedding
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
17807 Largo Place
Address Line 2
city
Cornelius
Fbstal / Zip Code
28031
r Yes
r No
Randy Jordan
Lyfe Marine, Inc,
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Frovince / Region
NC
Country
United States

Mailing Address:*
Street Address
19109 W. Catawba Ave.
Address Line 2
Suite 200
City
Cornelius
Fbstal / Zip Code
28031
Asigned and dated copy of the Agent Authorization letter:*
Wedding Agent Authorization.pdf 276.6KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Wedding Shoreline
State / Province / Region
NC
Country
United States
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 ovvner 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.*
r Upload File
r Lookup address
Upload Map: Wedding map.pdf
Latitude:* 35.458232
79.67KB
Longitude:*-80.903250
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*
Wedding diagram.pdf 69.35KB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/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.)*
Wedding photo l.jpg
7.09MB
Wedding Photo 2.jpg
6.06MB
Wedding Photo 3.jpg
4.44MB
Wedding Photo 5.jpg
4.46MB
Wedding Photo 5.jpg
4.46MB
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:* 17807 Largo Place Cornelius, NC 28031
Include phase/lot number
Directions to site:*
77-N to Exit 28; turn left onto Catawba Ave. to right onto Nantz Rd. to
right onto Largo Place.
17807 is on the Right.
Rease include road nacres and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential home with existing shoreline stabilization and dock.
Residential, undeveloped, etc.
6. Property Size .89
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Rip Rap repairs: add additional Class "B" rip rap to the existing rip rap
shoreline in 4 locations; 21'xY, 15'xY, 13'x5', 13'xY. Install new rip rap
on a 3'x8' section w/ geo tech fabric as underlayment.
8. How will the work be done? * m From Land
r 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.)
210
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.)
70
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)
Flat, grassy yard
Sketch: Wedding diagram.pdf 69.35KB
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 $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:
a I have given true, accurate, and complete information on this form;
a I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions Act")
a 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");
a I 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 this form.
Full Name:* Randy Jordan
Signature:
1?,914dI ,T4)114

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200896
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
rYes allo
Version:* 1
Alan Johnsomeads\adjohnsonl
Mooresville Regional Office - [phone]
r No Payment Needed
r Fee Received
r Need Fee - send electronic notification
r $240.00
f $570.00

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO\1 [' � PLAN NO. PARCEL ID:
STREET ADDRESS: _ (�gol 1-4! c / /We
.f..._.,.,. _
/iWt IioI IL16 .�A a �s 1
Please print: /
Property Owner: V"
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
of
(Contractor 1 Agent) (Dame of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: t\!&—\ — \Alz� `��.
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date'. Date:

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(Pr-ErltJde dtJwrrSonq for ftch iteer , 3.Lrch Q3 1.0 K j 00 fib•;
1. All 15WPOsed weget3tion hearing
2. Location of tip rap or fill to h'r placed abawe the Full Fond{ MUMaI WaI-ar Lewel ellewation
I l.ocak ion pf rip rap or filF to I)e Maud below *1e Full Pond/ AItrma I Wo Wr Lovel' elevation
4- Lor-atlon of Zily praPosed structures such as buildPngsr rexairning waIISr dOcksr etc.
5. i_ocatign of any exc�va#jon or dredging h-@lvw th-e F ull Fond/ NorrrQ1 Water Lwwl -RIe+ation
6. b3cdtion of banstructi i aoukss CBrrrdors
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