20240010 Ver 1_Shoreline Stabilization_20240102

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: *
office@lwdcllacom
Please provide an email address for payment and requests for more information here.
.................................
Cameron & Tiffany Douglas
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
17901 Wilbanks Drive
Address Line 2
City
Charlotte
Postal / Zip Code
28278-8576
Is there an agent working on the project?* Yes
No
Agent/Consultant Information
Name: *
Company Affiliation:
Email: *
Phone Number:*
Lake Wylie Dock Construction LLC
Nicol Prophet
office@lwdcllacom
[phone]
(xxx)xxx-xxxx
State / Province / Region
NC
Country
Us

Mailing Address: *
Street Address
1975 Gold Hill Road
Address Line 2
City
Fort Mill
Postal / Zip Code
29708-9311
A signed and dated copy of the Agent Authorization letter:
Agent Authorization.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:* Douglas Rip Rap
State / Province / Region
SC
Country
US
262.6KB
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
Property Address Lookup:* Street Address
17901 Wilbanks Drive
Address Line 2
City
State / Province / Region
Charlotte
NC
Postal / Zip Code
Country
28278-8576
US
Latitude: * 35.055528
Longitude: *-81.043820
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 *
Please use the diagram at the link below:
https:Hedocs.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.)
4. Location of the property (where work is to be conducted)

Nearest Town: * Charlotte
County: * Mecklenburg
Lake/ river/ ocean adjacent to Wylie
property:
Subdivisions name or site address: * 17901 Wilbanks Drive Charlotte, NC 28278
Include phase/lot number
Directions to site: *
From Buster Boyd Bridge towards Charlotte
Turn right onto Grand Palisades Pkwy
0.3 mi
Continue straight to stay on Grand Palisades Pkwy
1.7 mi
At the traffic circle, take the 3rd exit onto Youngblood Rd
0.6 mi
Turn right onto McKee Rd
1.3 mi
Continue onto Bankhead Rd
0.8 mi
Turn right to stay on Bankhead Rd
0.1 mi
Slight right onto Wilbanks Dr
Destination will be on the 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:
Typical rip rap job on shoreline, no existing rip rap all rip rap brought in via barge by water
Residential, undeveloped, etc.
6. Property Size 0.412
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
no current rip rap at all shoreline has never had rip rap, new neighborhood, all work done via barge by water.
8. How will the work be done?* From Land
I 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.)
300
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.)
0
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)
none we are only install by by water no sketch needed No impact to
vegetation
Sketch: Douglas Site Plan.pdf 1.56MB
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 $323.00 for impacts to lake (below normal water level) of less than 1 acre
d $767.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
o I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
o 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.
o 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');
o 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');
0 1 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:* Nicol Prophet
Signature:
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Submittal Date: 12/14/2023

Initial Review
Is this accepted into the review process?* Yes No
Project Number:* 20240010 Version: *
Select Reviewer: *
Select Reviewing Office
Has payment been received?*
What amount is owed?*
Andrew Pitner:andrew.pitner
Mooresville Regional Office - [phone]
No Payment Needed
Fee Received
Need Fee - send electronic notification
$240.00 $570.00
$323.00
$767.00