20230560 Ver 1_Corrected Application_20230619

Submission Form
L 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:*
[e-mail]
Phone Number:
[phone]
()=)Xoa-xxxx
Mailing Address:*
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:*
Waterside Docks & Piers
Email:* [e-mail]
State I Province / Region
NC
Country
us

Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
164 Stunts Road
Address Line 2
City
State / Province / Region
Mooresville
NC
Postal / Zip Code
Country
28117
US
A signed and dated copy of the Agent Authorization letter:*
Scarrow Agent Authorization.pdf 1.08MB
Scanow Agent Authorization 2.pdf 379.64KB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* scarrow inch
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:* 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://ed ocs.deq. nc.gov/WaterResou rces/0/edoc/616616/Shorel ine%20Layout.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 111
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, dp 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.)
750
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):
d $240.00 for impacts to lake (below normal water level) of less than 1 acre

q $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
q I the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
a 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.
a I agree that submission of this Shoreline Stabilization on line 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');
q I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
a 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 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