20200673 Ver 1_Shoreline Stabilization_20200521

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/21/2020 12:12:24 PM (Submittal)
Approve by Montalvo, Sheri A 5/21/2020 3:07:00 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 5/21/2020 12:12 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:*
Jamie Baker
Email:*
jamiesbaker21 @yahoo.com
Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address:*
Street Address
3726 Lake Shore Rd S
Address Line 2
City
Denver
Fbstal / Zip Code
28037-8237
Is there an agent working on the r Yes
project?* r No
Agent/Consultant Information
Name:* Randy Jordan
Company Affiliation:* Lyfe Marine, Inc.
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
State / Rovince / Fbgion
NC
Country
us

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:*
Agent Authorization -Jamie Baker.pdf 215.77KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Jamie Baker Rip Rap
State / Rovince / 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 owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that ha\e 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: Jamie Baker Map.pdf
Latitude:* 35.504290
305.99KB
Longitude:*-80.984530
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*
Jamie Baker Diagram.pdf 227.9KB
Jamie Baker plat.pdf 649.05KB
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.)*
Jamie Baker Photo 1.jpg 205.14KB
Jamie Baker Photo 2.jpg 197.64KB
Jamie Baker Photo 3.jpg 184.35KB
Jamie Baker Photo 4.jpg 239.82KB
4. Location of the property (where work is to be conducted)
Nearest Town:* Denver
County:* Lincoln

Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address:* 3726 Lake Shore Rd S Denver, NC 28037
Include phase/lot nunber
Directions to site:*
16-N to Right onto Optimist Club Rd. to L onto Triangle Cir. to L
onto NC-16 Business to R onto Fairfield Forest Rd. to R onto
Barker Ln. to R onto Lake Shore Rd S. 3726 is on the left.
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:*
Residential w/ e)asting shoreline stablization
Fbsidential, undeveloped, etc.
6. Property Size .53
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Push existing rip rap down, shape bank, instal geo-tech fabric, add
rip rap to fill in as needed and blend with existing rip rap. Remove
1 tree.
8. How will the work be done? * V From Land
F From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
240
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 w alls, etc.)
40
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)
Rip rap on shoreline/ grass yard above
Sketch: Jamie Baker Diagram.pdf 227.9KB
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;
o 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');
• 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:* 20200673
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

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO � PLAN NO.
1;� VXIA X�
PARCELID:
STREET ADDRESS
Please print:
Property Owner: -
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
of
(Contractor J Agent) (Name 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����
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
A14orizecl Signature
Date: 6 6 ,,�o
Authorized Signature
Date:

512112020
3726 Lake Shore Rd S - Google Maps
Go gle Maps 3726 Lake Shore Rd S
Jamie Baker
9
9F
Go gle
Map data 02020 500 ft
3726 Lake Shore Rd S
Denver, NC 28037
0 (A)
Directions Save Nearby
Send to your Sharp
phone
Photos
https.,Iiwww.google-comlmapslplace)3726+Lake+Shorc+Rd+S,+Dcnvu,+NC+280371@35.5034255,-80.9923Z75,167Jdata--!4m5!3rn4! I 112

Lake
Mt Full Pond/Normal Water Level)
Norm;
5
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as loft x too ft)*:
3. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation,
4, Location of any proposed structures such as buildings, retaining walls, docks, etc.
S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013
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Lake
Mt Full Pond/Normal Water Level)
Norm;
5
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as loft x too ft)*:
3. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation,
4, Location of any proposed structures such as buildings, retaining walls, docks, etc.
S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013
Page 3 of 3

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