20201067 Ver 1_Shoreline Stabilization_20200820

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/19/2020 5:03:35 PM (Submittal)
Approve by Montalvo, Sheri A 8/20/2020 1:55:52 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 8/19/2020 5:03 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.
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 rmre information here.
Fred Mama
Finann] [e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
18736 Bluff Pt Rd
Address Line 2
city
Cornelius
Postal / Zip Code
28031
a Yes
d No
......................................................................................
Mickey Larson
Owner/ LKN PERMITS, LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
/ Province / Region
NC
Country
United States

Mailing Address:* Street Address
109 Kase Court
Address Line 2
city
State / Rovince / Region
Mooresville
North Carolina
Fbstal / Zip code
country
28117
United States
Asigned and dated copy of the Age nt Authorization letter:*
Fred Mann Auth form.pdf 230.87KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Fred Mann Dredge
If your project has a formal name please use this. If your project does not ha),e 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
t: Look up address
Property Address Lookup:*
Latitude:* 35.454557
Street Address
18736 Bluff Point Road
Address Line 2
City
Cornelius
Fbstal / Zip Code
28031-7962
State / Province / Fbgion
NC
Cbuntry
US
Longitude:*-80.890396
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*
Fred Mann Sketch of Dredge Cut.pdf 499.08KB
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.)*
Fred Mann Dock photo for Dredge.pdf 526.12KB
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:* Bluff Point Lot 3
Include phase/lot number
Directions to site:*
Starting From: Marshall Steam Station
8320 NC-150, Sherrills Ford, NC 28673
Head south toward NC-150 E
57 s (0.2 mi)
Continue on NC-150 E. Take I-77 S to Bluff Point Rd in Cornelius
24 min (16.8 mi)
Turn right onto Bluff Point Rd
Destination will be on the left
24 s (0.1 mi)
18736 Bluff Point Rd
Rease include road narres and numbers, landrrerks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential Boat Access Channel,
Dredge 10 feet around Dock for boat access
30x40x6
Residential, undeveloped, etc.
6. Property Size 0.92
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Project site requires approval to excavate approx 600 cy of accumulated
sediment.
Dredging 10 ft of each side of the dock for the purpose of boat access
channel. 30 x 40 x
Material will be excavated using a long reach excavator, loaded onto a
Barge by water then offloaded into Dump truck and transported to an
approved site at Amity Hill Landfill
600 cy
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.)
6 ft deep
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
30 x 40 cut
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)
Soil, Sediment, Sand
Sketch: Fred Mann Sketch of Dredge Cut.pdf 499.08KB
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):
$240.00 for impacts to lake (below normal water level) of less than 1 acre
$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');
• 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 CIO LKN PERMITS, LLC
Signature:
Ai,c� CWA&C/PC,Cigum Le

Initial Review
Is this accepted into the review
process?*
Project Number:* 20201067
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

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: I ) PLAN NO: PARCEL ID: LV 1
STREET ADDRESS:
163
Please print:
Property Owner: J ,l "; '�
Property Owner: I �, 1
The undersigned, registered property owners of the above noted property, do herebyauthorize
(Contractor/Agent) (Name of consults 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 Owners Address (if different than property above):
t "Gt it�.5TV
Telephone: 1
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Auth rized Signature
17
Authorized Signature
Date

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