20200652 Ver 1_Shoreline Stabilization_20200518

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/18/2020 4:43:37 PM (Submittal)
Approve by Montalvo, Sheri A 5/18/2020 11:29:44 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 5/18/2020 4:44 PM

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.
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:*
Norman & Young LLC c/o Scott Young
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
4905 Knob View Court
Address Line 2
City
Winston Salem
Fbstal / Zip Code
27104
r Yes
r No
Mickey Larson
Owner/ LKN PERMITS, LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Rovince / Fbgion
NC
Country
USA

Mailing Address:*
Street Address
4688 Mtn Creek Ave
Address Line 2
city
Denver
Fbstal / Zip Code
28037
Asigned and dated copyof the Agent Authorization letter:*
Scott Young Auth Form.pdf 1.66MB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
...................................................................................................................................................................................................
Project Name:* Norman & Young LLC c/o Scott Young
State / Rovince / Region
NC
Country
USA
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. *
f Upload File
r Lookup address
Property Address Lookup:*
Latitude:* 35.664697
Street Address
310 Windermere Isle Rd
Address Line 2
City
Statesville
Fbstal / Zip Code
28677
State / Frovince / Pegion
NC
Country
USA
Longitude:*-80.963162
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*
Photos of 310 Windermere Isle.pdf 43.97MB
Please use the diagram at the link below:
https://edocs.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.)*
Photos of 310 Windermere Isle.pdf 43.97MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Statesville
County:* Iredell

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* Lot 24 Windermere Isle
Include phase/lot nunber
Directions to site:*
Marshall Steam Station
8320 NC-150, Sherrills Ford, NC 28673
Head south toward NC-150 E
1 min (0.2 mi)
Follow NC-1 50 E and Perth Rd to Hicks Creek Rd in Fallstown
16 min (11.3 mi)
Follow Hicks Creek Rd to E Monbo Rd
3 min (2.0 mi)
Turn left onto E Monbo Rd
3 min (2.1 mi)
Follow E Monbo Rd to Windemere Isle Rd
3 min (1.4 mi)
310 Windemere Isle Rd
Rease include road naves and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Existing Residential Lot is undeveloped
Shoreline is eroding
Trees have fallen from Storm Damage and high winds over the
years
Fbsidential, undeveloped, etc.
6. Pro pertySize 0.50
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Deliver and Install Class B Rip/Rap to enhance, stabilize and
prevent further erosion of entire Shoreline.
Undeveloped Residential Lot, currently eroding Shoreline and
damage caused from fallen trees due to storm damage.
8. How will the work be done? * r From Land
V 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.)
4
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.)
4
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*

(nunber of trees, for instance)
Eroding Shoreline, fallen trees from storm damage
Sketch: Photos of 310 Windermere Isle.pdf 43.97MB
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:
• I have given true, accurate, and complete information on this form;
• 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")
• 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');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
• I intend to electronically sign and submit this form.
Full Name:* Mickey Larson
Signature:
�r Atx'ea, 1, w

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200652
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
r Yes f No
Version:* 1
Alan Johnson:eads\adjohnson1
Mooresville Regional Office - [phone]
r No Payment Needed
f Fee Received
r Need Fee - send electronic notification
* $240.00
f $570.00

4
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