20230560 Ver 1_Shoreline Stabilization_20230420

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* [e-mail]
Please provide an email address for payment and requests for more information here.
Pre -Filing Meeting Date Request was 4/17/2023
submitted on: *
Owner Information:
........ ......... ........ ........
Name: * Mark Scarrow
Email: *
Phone Number:
Mailing Address: *
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
15800 Henry Lane
Address Line 2
City
Huntersville
Postal / Zip Code
28078-8944
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
...............................................................................................................................................................................
Name: * Randy Keith
Company Affiliation:
Email: *
Waterside Docks & Piers
[e-mail]
State / Province / Region
NC
Country
US

Phone Number:*
[phone]
(xxx)xxx-xxxx
Mailing Address: *
Street Address
164 Stuffs Road
Address Line 2
City
Mooresville
Postal / Zip Code
28117
A signed and dated copy of the Agent Authorization letter:
Scarrow Agent Authorization.pdf
Scar ow Agent Authorization 2.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: * scar ow Inch
State / Province / Region
NC
Country
US
1.08MB
379.64KB
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
Upload Map:
Latitude: * 35.427262
Longitude: *-80.916000
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*
site
Please use the diagram at the link below:
https:Hedocs.deq. nc.gov/WaterResou rces/0/edoc/616616/Shorel i ne%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: * Huntersville
County: * Mecklenburg
Lake/ river/ ocean adjacent to Lake Norman
property:
Subdivisions name or site address: * 15800 Henry Lane Lot 4 sec 1
Include phase/lot number
Directions to site: *
177 N, exit 25, left on Sam Furr road, merge left onto Hwy 73 toward Denver NC. Take right on Henry Lane, first on 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 waterfront home
Residential, undeveloped, etc.
6. Property Size 1.11
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
Dredge for dock and boating channel. Shoreline is currently stabilized 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.)
2400
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.)
7500
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)
no trees or vegetation required to be removed below or above the 760 elevation.
Owner will replant grass upon completion.
Sketch: Scarrow scale site plan.pdf 655.66KB
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):
1 $240.00 for impacts to lake (below normal water level) of less than 1 acre

d $570.00 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
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.
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');
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');
d 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 the Shoreline Stabilization online form.
Full Name:* G Randy Keith
Signature:
Submittal Date: 4/17/2023

Initial Review
Is this accepted into the review process?* Yes O No
Project Number: * 20230560 Version:*
Select Reviewer: *
Select Reviewing Office
Has payment been received?*
What amount is owed?*
Andrew Pitner:[e-mail]
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification
$240.00
$570.00

3 IS TO CERTIfY Im/A I vl%' "
)WN ON THIS PLAT, AND THAT
SHOWN HEREON.
LAKE NORMAN
THE PROPERTY LINES,
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LAKE NORMAN
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FRAME
STORAGE
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ZONING IS GR. SE713ACKS
SHOWN ARE PER CURRENT
ZONING ORDINANCE.
OTHER SETBACKS, EASEMENTS,
OR RIGHT OF WAYS MAY EXIST
WI-41CH MAY NOT BE SHOWN.
IMPERVIOUS AREA : _
Illlj 2,656
SF
GRAVEL DR.III
1,696
SF
HOUSE
WALKISTOOPS
324
SF
DECKIPATIO
1,258
SF
SF
DOCK
TOTAL
6,02187
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177 N, EXIT 25, LEFT ON SAM FURR, BARE LE
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THIS IS TO CERTIFY THAT ON THE .1 6TH DA Y
SHOWN ON THIS PLAT, AND THAT THE PROPERT
AS SHOWN HEREON.
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LAKE NORMAN r
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VICINITY MAP
PARCEL D #001-02:3-67.
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ZONING IS GR SETBACKS
/
SHOWN ARE PER CURRENT
/
ZONING ORDINANCE.
OTHER SETBACKS, EASEMENTS,
OR RIGHT OF WAYS MAY EXIST.
WH H MAY NOT BE SHOWN.
IMPERVIOUS AREA:
�/LOT
GRAVEL OR - 2,656 SF
HOUSE - 1, 696 SF LOT S
WALK/STOOPS - 324 SF
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DECK/PATIO - 11258 SF
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DOCK 0 -

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Please approximately sketch the following information on this plan, length of slPoreline
(provide dimensions for each item, such as 10 ft x 100 ft)
1 All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water'lil-evel elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water, evel elevation
4. Location of any proposed structures such as buildings, retaining walls, do i ks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Wat: r Level elevation
6. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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Envelope Id: 3C9C717CDAAD4FA5BA4FC1CA7D273851 Status: Completed
Subject: Complete with DocuSign: Scarrow--ToSign.pdf
Source Envelope:
Document Pages: 3
Certificate Pages: 4
AutoNav: Enabled
Signatures: 4
Initials: 0
Envelopeld Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 3/27/2023 7:15:04 AM
ID: 13988b09-ce1f-42fd-a3f7-4a809ac6bfea
Signature Adoption: Pre -selected Style
Using IP Address: 69,38.95.86
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In M,
00,
Envelope Originator:
Brittany McIntyre
8024 Calvin Hall Road
Indian Land, SC 29707
Brittany,[e-mail]
I Address: 69,132.70.177
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Envelope Sent Hashed/Encrypted 3/27/2023 7:11:27 AM
Certified Delivered Security Checked 3/27/2023 7:15:04 AM
Signing Complete Security Checked 3/27/2023 7:15:13 AM
Completed Security Checked 3/27/2023 7:15:13 AM